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1.
Sci Total Environ ; 753: 142068, 2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-32911174

RESUMEN

Biologically significant concentrations of organochlorine pesticides (OCPs) continue to be reported in wildlife populations and are of particular concern in species that occupy the highest trophic levels. Nile crocodiles (Crocodylus niloticus) are important apex predators occurring throughout much of tropical and subtropical sub-Saharan Africa, where they inhabit estuarine and freshwater habitats often impacted by contamination. In this study we examined pesticide residue accumulation in fat tissue from Nile crocodiles at Lake St Lucia, South Africa, where historically large quantities of OCPs have been used for agriculture and disease control. During 2019, we collected tail fat samples from wild (n = 21) and captive (n = 3) individuals to examine the influence of habitat, body size and sex on variations in bioaccumulation. The principal contaminant found was p,p'-DDE, a major persistent metabolite of DDT, which continues to be used in the region for combating malaria. Tissue p,p'-DDE concentrations in wild crocodiles (95-1200 ng g-1 ww) were significantly (p < 0.05) higher compared to captive individuals (23-68 ng g-1 ww) and strongly correlated (R2 > 0.70) to body length. Male (n = 14) and female (n = 7) wild crocodiles exhibited similar contaminant body burdens, however, total concentrations were substantially lower than those measured in the same population during 2016/2017. Marked differences in residue levels and profiles appear to reflect changes in food availability and dietary exposure associated with a shift in environmental conditions. These findings suggest that periods of environmental stress may be associated with enhanced toxicological risk in crocodiles. Additional work is needed to better understand contaminant accumulation and elimination mechanisms in crocodiles, and their potential effects on reproductive health.


Asunto(s)
Caimanes y Cocodrilos , Hidrocarburos Clorados , Plaguicidas , Animales , Bioacumulación , Femenino , Humanos , Hidrocarburos Clorados/análisis , Masculino , Plaguicidas/análisis , Sudáfrica
2.
Environ Monit Assess ; 192(12): 750, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33155083

RESUMEN

4-tert-Octylphenol (4-tOP) and triclosan (TCS) are endocrine disruptors which have been detected in environmental matrices such as air, soil and water at ultra-low levels. Exposure to endocrine disruptors may account at least in part, for the global increase in the incidence of non-communicable diseases like cancers and diabetes and may also lead to an imbalance in the aquatic ecosystem. River Buffalo is an important natural resource in the Eastern Cape of South Africa serving more than half a million people. The presence of the two compounds in the river water hitherto unknown was investigated during winter seasons using solid-phase extraction and gas chromatography-mass spectrometric techniques. The sampling points differed by some physicochemical parameters. The concentration of 4-tOP ranged 0-755 ng/L, median value 88.1 ng/L while that of TCS ranged 0-1264.2 ng/L and the median value was 82.1 ng/L. Hazard quotient as an index of exposure risk varied according to daphnids Ëƒ fish Ëƒ algae for 4-tOP exposure while HQ for TCS exposure was algae > daphnids = fish showing that both compounds were capable of causing imbalance in the aquatic ecosystem. Graphical abstract.


Asunto(s)
Disruptores Endocrinos , Contaminantes Químicos del Agua , Animales , Compuestos de Bencidrilo/análisis , Búfalos , Ecosistema , Disruptores Endocrinos/análisis , Disruptores Endocrinos/toxicidad , Monitoreo del Ambiente , Humanos , Medición de Riesgo , Sudáfrica , Contaminantes Químicos del Agua/análisis
3.
BMC Infect Dis ; 20(1): 816, 2020 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-33167886

RESUMEN

BACKGROUND: The prevalence of Staphylococcus aureus varies depending on the healthcare facility, region and country. To understand its genetic diversity, transmission, dissemination, epidemiology and evolution in a particular geographical location, it is important to understand the similarities and variations in the population being studied. This can be achieved by using various molecular characterisation techniques. This study aimed to provide detailed molecular characterisation of South African mecA-positive S. aureus blood culture isolates by describing the SCCmec types, spa types and to lesser extent, the sequence types obtained from two consecutive national surveillance studies. METHODS: S. aureus blood culture isolates from a national laboratory-based and enhanced surveillance programme were identified and antimicrobial susceptibility testing was performed using automated systems. A real-time PCR assay confirmed the presence of the methicillin-resistance determinant, mecA. Conventional PCR assays were used to identify the SCCmec type and spa type, which was subsequently analysed using the Ridom StaphType™ software. Multilocus sequence typing was performed on selected isolates using conventional methods. MRSA clones were defined by their sequence type (ST), SCCmec type and spa type. RESULTS: A detailed description of findings is reported in this manuscript. SCCmec type III predominated overall followed by type IV. A total of 71 different spa types and 24 novel spa types were observed. Spa type t037 was the most common and predominated throughout followed by t1257. Isolates were multidrug resistant; isolates belonging to all SCCmec types were resistant to most of the antibiotics with the exception of type I; isolates with spa type t045 showed resistance to all antibiotics except vancomycin. The most diverse SCCmec-spa type complex was composed of the SCCmec type IV element and 53 different spa types. CONCLUSION: Although ST data was limited, thereby limiting the number of clones that could be identified, the circulating clones were relatively diverse.


Asunto(s)
Proteínas Bacterianas/genética , Variación Genética , Secuencias Repetitivas Esparcidas/genética , Staphylococcus aureus Resistente a Meticilina/genética , Proteínas de Unión a las Penicilinas/genética , Infecciones Estafilocócicas/epidemiología , Proteína Estafilocócica A/genética , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Proteínas Bacterianas/sangre , Cultivo de Sangre , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Farmacorresistencia Bacteriana Múltiple/genética , Humanos , Meticilina/farmacología , Meticilina/uso terapéutico , Resistencia a la Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Tipificación de Secuencias Multilocus , Proteínas de Unión a las Penicilinas/sangre , Reacción en Cadena en Tiempo Real de la Polimerasa , Sudáfrica/epidemiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Vancomicina/farmacología , Vancomicina/uso terapéutico
4.
BMC Infect Dis ; 20(1): 836, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176715

RESUMEN

BACKGROUND: The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. METHODS: A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data. RESULTS: Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p < 0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p < 0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation. CONCLUSIONS: The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Monitoreo Epidemiológico , VIH-1/genética , Salud Rural , Carga Viral/métodos , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/virología , Adulto , Antirretrovirales/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural , Sudáfrica/epidemiología , Respuesta Virológica Sostenida , Carga Viral/efectos de los fármacos
7.
Afr J Prim Health Care Fam Med ; 12(1): e1-e4, 2020 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-33181872

RESUMEN

This short report captures the week-by-week reflections of a group of family physicians who joined the clinical and operational management teams tasked with providing the in-patient service of an 862-bed COVID-19 field hospital. The 'Hospital of Hope' at the Cape Town International Convention Centre (CTICC) was established as an intermediate care facility specifically to cope with the effects of the COVID-19 pandemic in Cape Town metropole. In an extraordinary feat of engineering, the conference centre floor was transformed within a matter of weeks into wards with piped oxygen at each bed. Whilst the emergency medicine specialists took the lead in designing and commissioning the facility, the medical management and staff were drawn mostly from family physicians. This report is a short reflection on the experience of the first 4 weeks of managing patients in this repurposed space. Our insights evolved during various formal and informal learning conversations as the in-patient service became more organised over time. We hope that these insights, as well as the process of reaching them, will assist other colleagues in serving their communities during this difficult moment in history; moreover, it may reflect a renewed appreciation for team-based interdisciplinary efforts in achieving person-centred care.


Asunto(s)
Infecciones por Coronavirus/terapia , Prestación de Atención de Salud/métodos , Hospitalización , Hospitales , Pandemias , Grupo de Atención al Paciente , Médicos de Familia , Neumonía Viral/terapia , Betacoronavirus , Manejo de Caso , Ciudades , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Servicios Médicos de Urgencia , Humanos , Unidades Móviles de Salud , Neumonía Viral/epidemiología , Neumonía Viral/virología , Sudáfrica/epidemiología
8.
Afr J Prim Health Care Fam Med ; 12(1): e1-e4, 2020 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-33181873

RESUMEN

Cape Town is currently one of the hotspots for COVID-19 on the African continent. The Metropolitan Health Services have re-organised their primary health care (PHC) services to tackle the epidemic with a community-orientated primary care perspective. Two key goals have guided the re-organisation, the need to maintain social distancing and reduce risk to people using the services and the need to prepare for an influx of people with COVID-19. Facilities were re-organised to have 'screening and streaming' at the entrance and patients were separated into hot and cold streams. Both streams had 'see and treat' stations for the rapid treatment of minor ailments. Patients in separate streams were then managed further. If patients with chronic conditions were stable, they were provided with home delivery of medication by community health workers. Community health workers also engaged in community-based screening and testing. Initial evaluation of PHC preparedness was generally good. However, a number of key issues were identified. Additional infrastructure was required in some facilities to keep the streams separate with the onset of winter. Managers had to actively address the anxiety and fears of the primary care workforce. Attention also needed to be given to the prevention and treatment of non-COVID conditions as utilisation of these services decreased. The epidemic exposed intersectoral and intrasectoral fault lines, particularly access to social services at a time when they were most needed. Community screening and testing had to be refocused due to limited laboratory capacity and a lengthening turnaround time.


Asunto(s)
Servicios de Salud Comunitaria/métodos , Infecciones por Coronavirus/terapia , Prestación de Atención de Salud/métodos , Instituciones de Salud , Planificación en Salud , Pandemias , Neumonía Viral/terapia , Atención Primaria de Salud/métodos , Betacoronavirus , Enfermedad Crónica , Ciudades , Agentes Comunitarios de Salud , Coronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Epidemias , Personal de Salud , Accesibilidad a los Servicios de Salud , Humanos , Tamizaje Masivo , Organizaciones , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/virología , Estaciones del Año , Sudáfrica/epidemiología , Triaje
9.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33181875

RESUMEN

The health-service redesign that came with the preparation for the surge of COVID-19 had a potential of disrupting the Family Medicine internship programme like it did to many other health and academic programmes. A team of Cape-Town based Community Health Centre (CHC) doctors mitigated this challenge by designing an innovative tool that facilitated ongoing supervision of the interns in order to achieve the outcomes of the Health Professions Council of South Africa (HPCSA).


Asunto(s)
Centros Comunitarios de Salud , Infecciones por Coronavirus , Consejo , Medicina Familiar y Comunitaria/educación , Internado y Residencia , Pandemias , Neumonía Viral , Preceptoría , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Personal de Salud , Humanos , Médicos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/virología , Sudáfrica
10.
J S Afr Vet Assoc ; 91(0): e1-e6, 2020 Sep 22.
Artículo en Inglés | MEDLINE | ID: mdl-33054249

RESUMEN

Although Pseudomonas aeruginosa (P. aeruginosa) can infect both animals and humans, there is a paucity of veterinary studies on antimicrobial resistance of P. aeruginosa in South Africa. Secondary data of canine clinical cases presented at the hospital from January 2007 to December 2013 was used. The following information was recorded: type of sample, the date of sampling and the antimicrobial susceptibility results. Frequencies, proportions and their 95% confidence intervals were calculated for all the categorical variables. In total, 155 P. aeruginosa isolates were identified and included in this study. All the isolates were resistant to at least one antimicrobial (AMR), while 92% were multi-drug resistant (MDR). Most isolates were resistant to lincomycin (98%), penicillin-G (96%), orbifloxacin (90%), trimethoprim-sulfamethoxazole (90%) and doxycycline (87%). A low proportion of isolates was resistant to imipenem (6%), tobramycin (12%), amikacin (16%) and gentamicin (18%). A high proportion of MDR-P. aeruginosa isolates was resistant to amoxycillin-clavulanic acid (99%), tylosin (99%), chloramphenicol (97%) and doxycycline (96%). Few (6%) of MDR-P. aeruginosa isolates were resistant to imipenem. Pseudomonas aeruginosa was associated with infections of various organ systems in this study. All P. aeruginosa isolates of P. aeruginosa exhibited resistance to ß-lactams, fluoroquinolones and lincosamides. Clinicians at the hospital in question should consider these findings when treating infections associated with P. aeruginosa.


Asunto(s)
Enfermedades de los Perros/microbiología , Farmacorresistencia Bacteriana Múltiple , Infecciones por Pseudomonas/veterinaria , Pseudomonas aeruginosa/efectos de los fármacos , Centros Médicos Académicos , Animales , Antibacterianos/clasificación , Antibacterianos/farmacología , Perros , Hospitales Veterinarios , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/fisiología , Sudáfrica
11.
PLoS One ; 15(10): e0241029, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33079951

RESUMEN

The SARS-CoV-2 pandemic has resulted in shortages of both critical reagents for nucleic acid purification and highly trained staff as supply chains are strained by high demand, public health measures and frequent quarantining and isolation of staff. This created the need for alternate workflows with limited reliance on specialised reagents, equipment and staff. We present here the validation and implementation of such a workflow for preparing samples for downstream SARS-CoV-2 RT-PCR using liquid handling robots. The rapid sample preparation technique evaluated, which included sample centrifugation and heating prior to RT-PCR, showed a 97.37% (95% CI: 92.55-99.28%) positive percent agreement and 97.30% (95% CI: 90.67-99.52%) negative percent agreement compared to nucleic acid purification-based testing. This method was subsequently adopted as the primary sample preparation method in the Groote Schuur Hospital Virology Diagnostic Laboratory in Cape Town, South Africa.


Asunto(s)
Betacoronavirus/genética , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Laboratorios de Hospital , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Robótica/métodos , Infecciones por Coronavirus/virología , Humanos , Pandemias , Neumonía Viral/virología , ARN Viral/genética , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Sudáfrica/epidemiología , Manejo de Especímenes
12.
Afr J AIDS Res ; 19(3): 263-268, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33119455

RESUMEN

Background: Health care workers play an integral role in the rehabilitation and care of people living with HIV who face multiple impairments and often disabilities. The aim of the article was to understand the perceptions and attitudes of health care workers towards caring for people living with HIV, and experiencing disability. Methods: Fifteen health care workers offering care to people living with HIV were interviewed using a semi-structured guide. These health care workers included doctors, a social worker, a pharmacist, a dietician, an occupational therapist, a physiotherapist, and nurses and HIV couPnsellors who were employed at a public health care facility in KwaZulu-Natal. Data from the interviews were transcribed and analysed using conventional content analysis. Results: Four themes emerged from semi-structured interviews with the health care workers: a holistic disability framework, a multidisciplinary team dynamic, organisational barriers and recommendations by health care workers. Conclusion: Health care workers perceived a shift from a biomedical perspective of disability to a bio-psychosocial interpretation that is influenced by contextual and environmental barriers imposed by communities on people living with HIV. Barriers included stigmatisation that leads to attitudinal barriers and social exclusion of people living with HIV and experiencing disabilities within communities. Lack of resources, including of equipment, and a shortage of health care staff also posed barriers to the care offered to people living with HIV and experiencing disabilities. Participants agreed that improved communication in the multidisciplinary health care team, as well as continuing education and training, would enable health care workers to offer improved, integrated care to people living with HIV who experience disabilities.


Asunto(s)
Personas con Discapacidad/rehabilitación , Infecciones por VIH/fisiopatología , Infecciones por VIH/rehabilitación , Personal de Salud/psicología , Prestación Integrada de Atención de Salud , Femenino , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/educación , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Investigación Cualitativa , Sudáfrica/epidemiología
13.
Afr J AIDS Res ; 19(3): 231-241, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33119456

RESUMEN

Research on adolescent sexuality, health and parenting has gained much attention in recent years. This growing body of research, however, has arguably limited qualitative outputs on HIV-positive adolescent mothers' sexual and reproductive health choices, needs, and rights in South Africa that could lead to informed policymaking. Through in-depth interviews conducted with a select group of ten HIV-positive adolescents and three key informants, the article explores the sexual, motherhood, risk discourses and reproductive health issues and rights of HIV-positive adolescent mothers as they come to terms with choices they have made and the challenges ahead. The findings highlight the dominant narratives on what are deemed to be the forces that shape these adolescent mothers' new social realities. With existing policies in place for adolescents, it is argued that a "one-size-fits-all" policy approach does not work, especially for HIV-positive adolescent mothers. Drawing on this identified gap and the tensions between individual needs, and the public welfare provision, the article highlights the need for tailored policy that will accommodate and promote the overall well-being of HIV-positive adolescent mothers and their children.


Asunto(s)
Infecciones por VIH/psicología , Mentores , Madres/psicología , Grupo Paritario , Adolescente/legislación & jurisprudencia , Femenino , Infecciones por VIH/epidemiología , Humanos , Mentores/legislación & jurisprudencia , Madres/legislación & jurisprudencia , Narración , Formulación de Políticas , Salud Reproductiva , Conducta Sexual , Sudáfrica/epidemiología
14.
Afr J AIDS Res ; 19(3): 242-248, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33119458

RESUMEN

The vulnerability of adolescents and young adults in South Africa to HIV and sexual violence is well documented. Post-exposure prophylaxis (PEP) is available for victims of sexual abuse in the country but awareness of this measure is required to maximise its HIV-prevention benefits. This study examined levels of PEP awareness and its correlates and the uptake of PEP among 772 students (16-24 years) in a South African university using stratified random sampling. Overall, we included more females (477) than males (295), reflecting the male-female ratio at the university. Adjusted and unadjusted logistic regression models were used to determine correlates of PEP awareness, which was low (24.1%), particularly among those who experienced sexual violence in the past year (19.8%) compared those who had not (24.8%). Only 2.6% of participants had used PEP, while 7.5% had seen it, and 14.6% knew where to get it. In the adjusted model, adequate family support (AOR: 2.22; CI: 1.54-3.20) and prior HIV testing (AOR: 2.65; CI: 1.59-4.42) were associated with a higher likelihood of PEP awareness. The study concluded that awareness of PEP was low in the study setting and especially among those who need it. Social marketing of PEP is needed in the study settings to realise the maximum benefits of PEP in preventing new HIV infections.


Asunto(s)
Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Profilaxis Posexposición/estadística & datos numéricos , Adolescente , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Masculino , Delitos Sexuales/estadística & datos numéricos , Sudáfrica/epidemiología , Estudiantes , Universidades , Adulto Joven
15.
BMC Infect Dis ; 20(1): 789, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33097000

RESUMEN

BACKGROUND: People successfully completing treatment for tuberculosis remain at elevated risk for recurrent disease, either from relapse or reinfection. Identifying risk factors for recurrent tuberculosis may help target post-tuberculosis screening and care. METHODS: We enrolled 500 patients with smear-positive pulmonary tuberculosis in South Africa and collected baseline data on demographics, clinical presentation and sputum mycobacterial cultures for 24-loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. We used routinely-collected administrative data to identify recurrent episodes of tuberculosis occurring over a median of six years after successful treatment completion. RESULTS: Of 500 patients initially enrolled, 333 (79%) successfully completed treatment for tuberculosis. During the follow-up period 35 patients with successful treatment (11%) experienced a bacteriologically confirmed tuberculosis recurrence. In our Cox proportional hazards model, a 3+ AFB sputum smear grade was significantly associated with recurrent tuberculosis with a hazard ratio of 3.33 (95% CI 1.44-7.7). The presence of polyclonal M. tuberculosis infection at baseline had a hazard ratio for recurrence of 1.96 (95% CI 0.86-4.48). CONCLUSION: Our results indicate that AFB smear grade is independently associated with tuberculosis recurrence after successful treatment for an initial episode while the association between polyclonal M. tuberculosis infection and increased risk of recurrence appears possible.


Asunto(s)
Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/genética , Esputo/microbiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Adulto , Femenino , Estudios de Seguimiento , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Repeticiones de Minisatélite/genética , Recurrencia , Factores de Riesgo , Sudáfrica/epidemiología , Resultado del Tratamiento , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/microbiología , Adulto Joven
16.
J Water Health ; 18(5): 753-765, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33095198

RESUMEN

Poorly operating wastewater treatment plants (WWTPs) result in faecal pollution of receiving waters, posing a health risk to humans and animals. The aim of this study was to determine the antimicrobial resistance patterns and presence of virulent genes in Enterococcus spp. isolated from three WWTPs' final effluent and receiving waters in the North West Province, South Africa. Sixty-three Enterococcus spp. were identified and their antimicrobial susceptibility, as well as the presence of five virulence genes, determined. The antibiotic inhibition zone diameter data were subject to cluster analysis. Sixty-eight percent of the screened Enterococcus spp. were resistant to three or more antibiotics and harboured plasmids. Five virulence genes were detected and six multi-virulence profiles observed. Cluster analysis indicated groupings of isolates from all three effluent points downstream together, and between plants 1 and 2 together. The findings of this study have demonstrated that Enterococcus spp. harbouring virulence factors and plasmids that mediate multiple antibiotic resistance are present in effluent and receiving water systems that support various social needs. This is a cause for concern and it is recommended that Enterococcus be used as an additional faecal indicator when microbiological quality of water is assessed.


Asunto(s)
Enterococcus , Aguas Residuales , Animales , Farmacorresistencia Microbiana/genética , Enterococcus/genética , Humanos , Prevalencia , Sudáfrica , Virulencia/genética
17.
J Water Health ; 18(5): 798-819, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33095202

RESUMEN

Interventions to reduce undernutrition and improve child growth have incorporated improved water, sanitation, and hygiene (WASH) as part of disease transmission prevention strategies. Knowledge gaps still exist, namely, when and which WASH factors are determinants for growth faltering, and when WASH interventions are most effective at improving growth. This study drew cross-sectional data from a longitudinal cohort study and used hierarchical regression analyses to assess associations between WASH factors: water index, sanitation, hygiene index, and growth: height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ) at 1, 6, and 12 months postpartum among infants a priori born healthy in Soweto, Johannesburg. Household access to sanitation facilities that were not safely managed was associated with a decrease in HAZ scores at 1 month (ß = -2.24) and 6 months (ß = -0.96); a decrease in WAZ at 1 month (ß = -1.21), 6 months (ß = -1.57), and 12 months (ß = -1.92); and finally, with WHZ scores at 12 months (ß = -1.94). Counterintuitively, poorer scores on the hygiene index were associated with an increase at 1 month for both HAZ (ß = 0.53) and WAZ (ß = 0.44). Provision of safely managed sanitation at household and community levels may be required before improvements in growth-related outcomes are obtained.


Asunto(s)
Saneamiento , Agua , Niño , Estudios Transversales , Femenino , Humanos , Higiene , Lactante , Estudios Longitudinales , Sudáfrica
18.
PLoS One ; 15(10): e0239304, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33006979

RESUMEN

Sub-Saharan Africa has been heavily impacted by the HIV/AIDS epidemic. Social data (e.g., social media, internet search, wearable device, etc) show great promise assisting in public health and HIV surveillance. However, research on this topic has primarily focused in higher resource settings, such as the United States. It is especially important to study the prevalence and potential use of these data sources and tools in low- and middle-income countries (LMIC), such as Sub-Saharan Africa, which have been heavily impacted by the HIV epidemic, to determine the feasibility of using these technologies as surveillance and intervention tools. Accordingly, we 1) described the prevalence and characteristics of various social technologies within South Africa, 2) using Twitter, Instagram, and YouTube as a case study, analyzed the prevalence and patterns of social media use related to HIV risk in South Africa, and 3) mapped and statistically tested differences in HIV-related social media posts within regions of South Africa. Geocoded data were collected over a three-week period in 2018 (654,373 tweets, 90,410 Instagram posts and 14,133 YouTube videos with 1,121 comments). Of all tweets, 4,524 (0.7%) were found to related to HIV and AIDS. The percentage was similar for Instagram 95 (0.7%) but significantly lower for YouTube 18 (0.1%). We found regional differences in prevalence and use of social media related to HIV. We discuss the implication of data from these technologies in surveillance and interventions within South Africa and other LMICs.


Asunto(s)
Monitoreo Epidemiológico , Infecciones por VIH/epidemiología , Medios de Comunicación Sociales/estadística & datos numéricos , Estudios de Factibilidad , Humanos , Salud Pública/estadística & datos numéricos , Sudáfrica/epidemiología
19.
PLoS One ; 15(10): e0239430, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33006993

RESUMEN

BACKGROUND: The achievement of the World Health Organization's END TB goals will depend on the successful implementation of strategies for early diagnosis and retention of patients on effective therapy until cure. An estimated 150,000 cases are missed annually in South Africa. It is necessary to look at means for identifying these missed cases. This requires the implementation of active surveillance for TB, a policy adopted by the National Department of Health. AIM: To explore the views of managers of the TB program on the implementation of active surveillance for TB in the resource constrained setting of the Eastern Cape, South Africa. METHODS: A descriptive, explorative, thematically analysed qualitative study based on 10 semi-structured interviews of managers of the TB program. Interviews were transcribed verbatim and analysed using the framework method and Atlas-ti. RESULTS: Active case finding of people attending health facilities was the dominant approach, although screening by community health workers (CHWs) was available. Both government and non-government organisations employed CHWs to screen door to door and sometimes as part of campaigns or community events. Some CHWs focused only on contact tracing or people that were non-adherent to TB treatment. Challenges for CHWs included poor coordination and duplication of services, failure to investigate those identified in the community, lack of transport and supportive supervision as well as security issues. Successes included expanding coverage by government CHW teams, innovations to improve screening, strategies to improve CHW capability and attention to social determinants. CONCLUSION: A multifaceted facility- and community-based approach was seen as ideal for active surveillance. More resources should be targeted at strengthening teams of CHWs, for whom this would be part of a comprehensive and integrated service in a community-orientated primary care framework, and community engagement to strengthen community level interventions.


Asunto(s)
Monitoreo Epidemiológico , Recursos en Salud/provisión & distribución , Tuberculosis/epidemiología , Humanos , Evaluación de Resultado en la Atención de Salud , Sudáfrica/epidemiología
20.
PLoS One ; 15(10): e0239720, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33017436

RESUMEN

BACKGROUND: Women with hyperglycaemia first detected in pregnancy (HFDP), including those with gestational diabetes mellitus (GDM), should undergo a glucose evaluation 4-12 weeks after delivery. Globally, suboptimal postpartum return rates limit the opportunity to intervene in women with sustained hyperglycaemia and pragmatic solutions should be sought to bridge this gap. OBJECTIVE: To assess the utility of postpartum in-hospital glucose evaluation to predict the outcome of the oral glucose tolerance test (OGTT) performed 4-12 weeks after delivery. METHODS: The study was performed prospectively at Tygerberg Hospital, Cape Town, South Africa. Women with HFDP, classified as GDM based on the modified National Institute for Health and Care Excellence criteria, who delivered between November 2018 and June 2019 were included in the study. Fasting plasma glucose (FPG) was performed 24-72 hours after delivery (t1) in the postnatal ward, provided glucose lowering medication was discontinued at delivery. An OGTT 4-12 weeks postpartum (t2) was scheduled for the total cohort. We compared glucose values and glucose categories at t1 and t2 and evaluated antenatal characteristics of women who returned, compared to the group that was lost to follow-up. RESULTS: In-hospital post-delivery glucose assessment (t1) was performed in 115 women. Glucose levels were significantly lower at t1 compared to antenatal diagnostic values (t0) and assessment at t2. Of the fourteen women with hyperglycaemia at t2, none had abnormal fasting glucose concentrations at t1. Women with HFDP who fulfilled criteria for overt diabetes at t0, all (24/115) had normal fasting glucose levels at t1 except for IFG in one (1/24). The antenatal characteristics of women with HFDP who returned at t2, were similar to the women who did not return. CONCLUSION: Based on this study, in-hospital fasting glucose 24-72 hours postpartum cannot replace the OGTT 4-12 weeks postpartum. Pragmatic solutions for low postpartum return rates in women with HFDP should be pursued.


Asunto(s)
Glucemia/análisis , Glucosa/metabolismo , Hiperglucemia/fisiopatología , Adulto , Estudios de Cohortes , Diabetes Mellitus Tipo 2/sangre , Diabetes Gestacional/sangre , Ayuno/sangre , Ayuno/fisiología , Femenino , Intolerancia a la Glucosa/sangre , Prueba de Tolerancia a la Glucosa , Humanos , Periodo Posparto/sangre , Embarazo , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Sudáfrica
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