Changing mortality amongst hospitalised children with Severe Acute Malnutrition in KwaZulu-Natal, South Africa, 2009 - 2018.

BACKGROUND: The under-five mortality rates of children in South Africa (SA) remain high despite successful HIV prevention and treatment programs. The in-hospital mortality of children with severe acute malnutrition remains a key obstacle. This study identifies and describes changes in the mortality of under-five children with severe acute malnutrition (SAM) following the implementation of HIV and malnutrition prevention and treatment programmes. METHODS: This was a retrospective review of in-hospital mortality records and databases. The study was based at a large referral hospital in KwaZulu-Natal (KZN), where HIV and malnutrition rates are high, and SAM children are managed with standard WHO guidelines. Records of children under five years old who died from 2009 to 2018 were analysed. RESULTS: Of the 698 under-five children who died in this period, 285 (40, 8% of all under-5 deaths) were classified as having SAM. The number of HIV-infected SAM deaths dropped significantly, especially those below six months of age, mirroring the expansion of HIV treatment and prevention programmes. Despite this and a significant drop in the proportion of SAM admissions identified, there was no change in SAM case fatality rates over the ten years. Septicaemia remained the most common cause of death in children with SAM. CONCLUSIONS: Despite significant decreases in HIV-related malnutrition deaths over ten years, the lack of change in SAM case fatality rates is a concern at this referral hospital. Standardised WHO inpatient management protocols, may require review, especially where underlying medical conditions may contribute to SAM deaths in HIV-negative children.

Genome Sequences of Three African Swine Fever Viruses of Genotypes IV and XX from Zaire and South Africa, Isolated from a Domestic Pig (Sus scrofa domesticus), a Warthog (Phacochoerus africanus), and a European Wild Boar (Sus scrofa).

We report here the genome sequences of three African swine fever virus isolates obtained from a domestic pig (Zaire [Zaire]), a warthog (RSA/W1/1999 [South Africa]), and a European wild boar (RSA/2/2004 [South Africa]) belonging to genotypes IV, XX, and XX, respectively. This report increases the number of genotype XX, wild boar, and warthog reference sequences available.

Genome Sequences of Three African Swine Fever Viruses of Genotypes I, III, and XXII from South Africa and Zambia, Isolated from Ornithodoros Soft Ticks.

Here, we report the draft genome sequences of three African swine fever viruses isolated from Ornithodoros soft ticks. Isolates LIV 5/40 (Zambia), SPEC 57 (South Africa), and RSA/2/2008 (South Africa) belong to genotypes I, III, and XXII, respectively.

When prevention is dangerous: perceptions of isoniazid preventive therapy in KwaZulu-Natal, South Africa.

SETTING: In 2011, the South African government began to offer isoniazid preventive therapy (IPT) through the public health system to presumptively treat latent tuberculous infection (LTBI) among people living with human immunodeficiency virus. OBJECTIVE: To describe IPT perceptions and experiences in three Zulu communities in KwaZulu-Natal Province, South Africa. DESIGN: Using a combination of community-based research and ethnographic methods, we undertook 17 individual and group interviews between October 2014 and May 2015. Interviews transcripts were analysed using qualitative content analysis and validated with grass-roots community advisors. RESULTS: Participants reported multiple ways in which IPT was perceived as dangerous: when costs related to pill collection or consumption were unsustainable, or when daily pill consumption resulted in stigma or was seen to introduce excess dirt or toxins, 'ukungcola', in the body. Theories on dirt are evoked to describe how IPT was perceived as 'matter out of place' when given to people who believed themselves to be healthy, suggesting that under the current TB aetiological model in Zulu culture, 'prevention as tablet' may not fit. CONCLUSION: Implementing IPT without understanding the realities of community stakeholders can unintentionally undermine TB control efforts by worsening the situation for people who already encounter numerous daily problems.

Attitudes of black South Africans to living related kidney transplantation.

UNLABELLED: Between September 1992 and April 2003, 96 patients in chronic renal failure had 134 potential related living donors. The aim of this study was to determine the factors that influence living related kidney transplantation among black South Africans. METHODS: Potential recipients and donors were screened for suitability to donate or receive kidneys. The relationship of the donor to the recipient was documented. RESULTS: Ninety-six potential recipients of median age 32 years (range, 7 to 53) and a female to male ratio of 1:1.6 had potential related donation from 47 sisters, 33 brothers, 27 mothers, 8 fathers, and 11 children. Eight potential donors were from cousins, spouses, stepbrothers, and friends. One, two, or three potential donors per recipient were counted among 54, 19, and 10 recipients, respectively. Contraindications to transplantation in 45 potential donors were ABO incompatibility (n = 19); hypertension (n = 11); HIV positivity (n = 10); and one each for nephrotic syndrome, gastric cancer, Hepatitis B, withdrawal, and a single functioning kidney. Thirty-five patients were transplanted from relatives. Although HLA-A, B, and DR antigens were studied in transplanted patients using both serologic and polymerase chain reaction-sequence-specific oligonucleotide methods, HLA matching was not used for donor selection. Only two living related pairs were HLA identical. Actual 1-year graft survival after transplantation was 95%. In conclusion, the concept of related living donation is acceptable among black South Africans and the number of donors per recipient suggests that HLA matching can be improved.

Insulin secretion, clearance and sensitivity in black pregnant and non-pregnant women in Harare, Zimbabwe.

OBJECTIVE: To assess whether reported gestational differences in glucose tolerance in Caucasian and Black women could be due to alterations in insulin secretion, clearance or sensitivity. DESIGN: Cross sectional survey. SETTING: Antenatal Clinic, Harare; Department of Medical Laboratory Sciences, University of Zimbabwe. SUBJECTS: 90 healthy women in all the trimesters of pregnancy and 30 healthy non-pregnant women of reproductive age. MAIN OUTCOME MEASURES: Fasting (basal) plasma insulin, C-peptide and glucose concentration. Fasting plasma C-peptide, C-peptide to insulin ratio and glucose to insulin ratio were used as indices of insulin secretion, hepatic insulin clearance and insulin sensitivity respectively. RESULTS: Not all means of the fasting plasma glucose levels amongst the four groups of women were equal (p < 0.001), with all possible comparisons being significant except for the first and second trimester groups. Among the comparisons of the means of the glucose:insulin ratio in the four groups of women, only the means of the first and second trimester women differed (mean difference = 0.23, honestly significance difference = 0.20). All groups were comparable in the means of plasma insulin, C-peptide levels and the C-peptide:insulin ratio. CONCLUSION: Since fasting plasma insulin, C-peptide and C-peptide:insulin ratio were not significantly altered in all trimesters of pregnancy, these data suggest normal basal insulin secretion and clearance during gestation in these sub-Saharan African women.

Attitudes of black South Africans concerning organ donation.

The availability of donor organs was analyzed following the placement of a transplant coordinator in Ga-Rankuwa Hospital's kidney transplant program. From February 1, 1992, to January 6, 1994, 44 brain-dead potential donors were identified. In 20 of those cases, relatives could not be reached to acquire consent for donation of cadaveric organs. In the remaining 24 cases, an intensive care resident together with a transplant coordinator obtained consent for 9 potential donors. Over the same period, 119 (80%) of living-related potential donors who had been approached stated that they were willing to donate a kidney. This outcome suggests that among blacks, altruism is a positive factor for acquiring consent for organ donation. Public education is required to correct ignorance, misconception, and cultural beliefs regarding cadaveric donation.