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1.
Water Sci Technol ; 80(3): 551-562, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31596266

RESUMO

Exposure to antibiotics, biocides, chemical preservatives, and heavy metals in different settings such as wastewater treatment plants (WWTPs) may apply selective pressure resulting in the enrichment of multiple resistant, co- and cross-resistant strains of bacteria. The purpose of this study was to identify and characterize potentially pathogenic triclosan (TCS) - and/or, chloroxylenol (PCMX) tolerant bacteria from sewage and river water in the North-West, Potchefstroom, South Africa. Several potential pathogens were identified, with Aeromonas isolates being most abundant. Clonal relationships between Aeromonas isolates found at various sampling points were elucidated using ERIC-PCR. Selected isolates were characterized for their minimum inhibitory concentrations against the biocides, as well as antibiotic resistance profiles, followed by an evaluation of synergistic and antagonistic interactions between various antimicrobials. Isolates were also screened for the presence of extracellular enzymes associated with virulence. High-performance liquid chromatography revealed the presence of both biocides in the wastewater, but fingerprinting methods did not reveal whether the WWTP is the source from which these organisms enter the environment. Isolates exhibited various levels of resistance to antimicrobials as well as several occurrences of synergy and antagonisms between the biocides and select antibiotics. Several isolates had a very high potential for virulence but further study is required to identify the specific virulence and resistance genes associated with the isolates in question.


Assuntos
Desinfetantes , Eliminação de Resíduos Líquidos , Águas Residuárias/microbiologia , Antibacterianos , Farmacorresistência Bacteriana/genética , Testes de Sensibilidade Microbiana , Rios , Esgotos , África do Sul
2.
Pan Afr Med J ; 33: 159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565121

RESUMO

Introduction: Hospital-based surveillance programs only capture people presenting to facilities and may underestimate disease burden. We conducted a healthcare utilisation survey to characterise healthcare-seeking behaviour among people with common infectious syndromes in the catchment areas of two sentinel surveillance hospitals in Johannesburg, South Africa. Methods: A cross-sectional survey was conducted within three regions of Johannesburg from August to November 2015. Premises were randomly selected from an enumerated list with data collected on household demographics and selected syndromes using a structured questionnaire. Fisher's exact or chi-square tests were used to determine association of characteristics among different regions. Results: Of 3650 selected coordinates, 3358 were eligible dwellings and 2930 (87%) households with 9850 individuals participated. Four percent of participants (431/9850) reported influenza-like illness (ILI) in the last 30 days; equal numbers of participants (0.2%, 20/9850) reported pneumonia or tuberculosis symptoms in the last year and <1% reported diarrhoea or meningitis symptoms. Sixty eight percent (295/431) of participants who reported ILI, 75% (6/8) of children with diarrhoea and all participants who reported pneumonia (20), tuberculosis (20) or meningitis (6) sought healthcare. For all syndromes most sought care at registered healthcare providers. Of these only 10% (24/237) attended sentinel hospitals, predominantly those that lived closer to the hospitals. In contrast, of patients with meningitis, 50% (3/6) sought care at sentinel hospitals. Conclusion: Patterns of seeking healthcare differed by syndrome and distance from facilities. Surveillance programs are still relevant in collecting information on infectious syndromes and reflect a proportion of the hospital's catchment area.


Assuntos
Doenças Transmissíveis/epidemiologia , Assistência à Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância de Evento Sentinela , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doenças Transmissíveis/terapia , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , África do Sul/epidemiologia , Inquéritos e Questionários , Síndrome , Adulto Jovem
3.
Waste Manag ; 99: 79-89, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473484

RESUMO

The world population is becoming more urbanized, wealthier but also more wasteful. The resolution of the problem of ever increasing amounts of solid waste is not yet a priority in many developing countries where informal organization has managed to partially tackle the problem. In this article we explore the interface between formal and informal waste management in the BRICS countries (Brazil, Russia, India, China and South Africa). The aim of this article is to comparatively evaluate the main challenges of urban solid waste management for the BRICS from an institutional point of view. Based on a literature review, interviews with experts on the BRICS and a search for relevant legislation and formal institutions, evidence of informal institutions and the informal economy's role following New Institutional Economics was considered. The results indicate that while in Brazil and South Africa there is a state incentive to formalize scavenging for more efficient outcomes, Russia shows a significant blind-spot on the issue, China apparently awaits a technological solution to the problem, and India's cultural, ethnic and caste-based divide of society make recent policies aimed at improving waste pickers' conditions challenging to enforce. This research has shown that it is not as much an issue of enforcement of the (often recent) legislations, but rather one of cultural and informal organizational factors, that play into the issue of continued problems concerning waste management. For achieving waste management policy goals, we suggest a more open multi-stakeholder approach to the inclusion of informal organizations in public waste management.


Assuntos
Gerenciamento de Resíduos , Brasil , China , Índia , Federação Russa , África do Sul
4.
Pan Afr Med J ; 33: 132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558931

RESUMO

Introduction: Studies have reported that emergency medical care practitioners (EMCPs) encounter challenges when attending to psychiatric emergencies. The EMC provider's ability to understand, assess and manage psychiatric emergencies has been reported to be poor due to limited knowledge and insufficient training. In South Africa (SA), little is known about the knowledge of EMCPs on pre-hospital management of psychiatric emergencies. The objective of this study was to assess the knowledge of EMCPs working in the Free State province on aspects of pre-hospital management of psychiatric emergencies. Methods: This descriptive study used a questionnaire survey to obtain data on the knowledge of EMCPs on aspects of pre-hospital management of psychiatric emergencies. Results: Only 159 of the initial 192 questionnaires distributed were returned, giving a response rate of 82.8%. The majority (87.4%) of the participants reported inadequate knowledge of pre-hospital management of psychiatric emergencies. More than a third of the participants reported that they are not knowledgeable on how to assess a psychiatric patient (P < 0.01), 64.2% and 73.6% (P < 0.001 in both cases) could not perform mental status examination and lack the knowledge of crisis intervention skills for managing a psychiatric emergencies. The majority (76.7%; P < 0.001) of the participants are not conversant with the Mental Health Care Act 2002 (Act no. 17 of 2002). Finally, participants (94.3% and 86.8%, respectively; P < 0.001) agree that teaching and prior exposure to a psychiatric facility, as in work integrated learning, will empower EMC graduates with skills required to effectively manage psychiatric emergencies. Conclusion: EMC practitioners are often the first healthcare professionals arriving at any scene of medical emergencies including psychiatric emergencies. To avoid malpractices, which could be detrimental to patient's health, it is of utmost importance that EMCPs are well trained and equipped to manage any form of medical emergency including those involving psychiatric patients.


Assuntos
Serviços Médicos de Emergência/métodos , Socorristas/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais/terapia , Adulto , Competência Clínica , Emergências , Serviços Médicos de Emergência/normas , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Projetos Piloto , África do Sul , Inquéritos e Questionários , Adulto Jovem
5.
J Glob Health ; 9(2): 020413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448114

RESUMO

Background: Past studies have demonstrated how single non-communicable diseases (NCDs) affect health care utilisation and quality of life (QoL), but not how different NCD combinations interact to affect these. Our study aims to investigate the prevalence of NCD dyad and triad combinations, and the implications of different NCD dyad combinations on health care utilisation and QoL. Methods: Our study utilised cross-sectional data from the WHO SAGE study to examine the most prevalent NCD combinations in six large middle-income countries (MICs). Subjects were mostly aged 50 years and above, with a smaller proportion aged 18 to 49 years. Multivariable linear regression was applied to investigate which NCD dyads increased or decreased health care utilisation and QoL, compared with subjects with only one NCD. Results: The study included 41 557 subjects. Most prevalent NCD combinations differed by subgroups, including age, gender, income, and residence (urban vs rural). Diabetes, stroke, and depression had the largest effect on increasing mean number of outpatient visits, increasing mean number of hospitalisation days, and decreasing mean QoL scores, respectively. Out of the 36 NCD dyads in our study, thirteen, four, and five dyad combinations were associated with higher or lower mean number of outpatient visits, mean number of hospitalisations, or mean QoL scores, respectively, compared with treating separate patients with one NCD each. Dyads of depression were associated with fewer mean outpatient visits, more hospitalisations, and lower mean QoL scores, compared to patients with one NCD. Dyads of hypertension and diabetes were also associated with a reduced mean number of outpatient visits. Conclusions: Certain NCD combinations increase or decrease health care utilisation and QoL substantially more than treating separate patients with one NCD each. Health systems should consider the needs of patients with different multimorbidity patterns to effectively respond to the demands on health care utilisation and to mitigate adverse effects on QoL.


Assuntos
Países em Desenvolvimento , Multimorbidade/tendências , Doenças não Transmissíveis/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Adolescente , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Federação Russa/epidemiologia , África do Sul/epidemiologia , Adulto Jovem
6.
Stud Health Technol Inform ; 264: 1437-1438, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438169

RESUMO

Prostate cancer (PCa) data is of public health importance in South Africa. Biopsy data is recorded as semi-structured narrative text that is not easily analysed. Our study reports a pilot study that applied predictive analytics and text mining techniques to extract prognostic information that guides patient management. In particular, the Gleason score (GS) reported in a number of formats were extracted successfully. Our study reports that predominantly older men were diagnosed with PCa reporting a high-risk GS (8-10). Where cell differentiation was reported, 64% of biopsies reported poor differentiation. The approaches demonstrated in our study should be extended to a larger dataset to assess whether it has the potential to scale up to the national level.


Assuntos
Big Data , Neoplasias da Próstata , Humanos , Masculino , Gradação de Tumores , Projetos Piloto , África do Sul
7.
Pan Afr Med J ; 33: 42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384357

RESUMO

Introduction: We investigated an outbreak of influenza-like illness (ILI) at a boarding school in Eastern Cape Province, South Africa. We aimed to confirm the etiological agent, estimate attack rates and identify risk factors for illness. Methods: We conducted a retrospective cohort study including senior school boarders (n=308). Students with ILI (cough and fever) were identified through school medical records. We also conducted a questionnaire-based cross-sectional study among senior students including boarders (n=107) and day students (n=45). We collected respiratory specimens for respiratory pathogen testing by real-time polymerase chain reaction from a subset of symptomatic students. We calculated attack rates of medically attended ILI (medILI) and identified factors associated with medILI using logistic regression. We calculated seasonal influenza vaccine effectiveness (VE) against medILI. Results: Influenza A (H3N2) virus was detected in 61% (23/38) of specimens. Attack rate for medILI was 13% among boarders (39/308) in the cohort study and 20% in both day students (9/45) and boarders (21/107) in the cross-sectional study. Playing squash was associated with medILI (aOR 5.35, 95% confidence interval [95% CI]: 1.68-17.07). Of the boarders, 19% (57/308) were vaccinated before the outbreak. The adjusted VE against medILI was 18% (aOR 0.82, 95% CI 0.38-1.78). The outbreak led to cancellation of several events and the need for academic remedial sessions. Conclusion: We confirmed an influenza A (H3N2) virus outbreak with a high attack rate. The outbreak affected academic and sports activities. Participation in sports and social gatherings while experiencing ILI should be discouraged to reduce viral transmission and impact on school activities.


Assuntos
Surtos de Doenças , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Vacinas contra Influenza/administração & dosagem , Influenza Humana/epidemiologia , Adolescente , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Influenza Humana/virologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Instituições Acadêmicas , África do Sul/epidemiologia , Estudantes , Adulto Jovem
8.
Stud Health Technol Inform ; 264: 20-24, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437877

RESUMO

Supported by the European Commission under Horizon 2020, mHealth4Afrika is co-designing and validating a modular, multilingual, state-of-the-art health information system addressing primary healthcare requirements in resource constrained environments. mHealth4Afrika has co-designed a comprehensive range of functionality and medical programs in partnership with Ministries of Health, district health officers, clinic managers and primary healthcare workers from urban, rural and deep rural health facilities in Ethiopia, Kenya, Malawi and South Africa. This paper provides insights into how mHealth4Afrika is leveraging HL7 FHIR to support standards-based data exchange and interoperability between Electronic Medical Records and DHIS2. This work is currently being validated in the field.


Assuntos
Registros Eletrônicos de Saúde , Disseminação de Informação , Humanos , Quênia , Malaui , África do Sul
9.
J S Afr Vet Assoc ; 90(0): e1-e7, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31368316

RESUMO

The objective of this study was to gain better insight into factors associated with the capture-related mortality rate in cheetahs. A link to an online questionnaire was sent to zoo and wildlife veterinarians through the Species Survival Plan Programme and European Endangered Species Programme coordinators and via the 'Wildlife VetNet' Google group forum. The questionnaire consisted of 50 questions relating to the veterinarians' country of residence and experience, the medicine combinations used, standard monitoring procedures, capture-related complications and mortalities experienced in this species under different capture conditions. In addition, necropsy data from the national wildlife disease database of the National Zoological Gardens of South Africa were examined for cases where anaesthetic death was listed as the cause of death in cheetahs. A total of 75 veterinarians completed the survey, with 38 from African countries and a combined total of 37 from Europe, the United States (US) and Asia. Of these, 24% (n = 18/75) had experienced at least one capture-associated cheetah mortality, with almost all of the fatalities (29/30) reported by veterinarians working in Africa. A lack of anaesthetic monitoring and the absence of supplemental oxygen were shown to be significant risk factors for mortality. Hyperthermia, likely to be associated with capture stress, was the most common reported complication (35%). The results suggest that free-ranging rather than habituated captive cheetahs are particularly at risk of dying during immobilisation and transport. The capture-related fatalities in this species do not appear to be associated with either the veterinarian's level of clinical experience or the immobilisation agents used.


Assuntos
Acinonyx , Anestésicos Dissociativos/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Imobilização/veterinária , Mortalidade , Animais , Animais Selvagens , Animais de Zoológico , Autopsia/veterinária , Bases de Dados Factuais , Combinação de Medicamentos , Europa (Continente) , Imobilização/efeitos adversos , Imobilização/métodos , Ketamina/efeitos adversos , Modelos Logísticos , Medetomidina/efeitos adversos , Fatores de Risco , África do Sul/epidemiologia , Inquéritos e Questionários , Tranquilizantes/efeitos adversos , Médicos Veterinários
10.
Stud Health Technol Inform ; 265: 48-53, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431576

RESUMO

Community Health Workers (CHW) perform important healthcare and health promotion in many low and middle income countries. They are increasingly supported in their work by the use of mHealth. This study aims to explore how mHealth services can support the everyday work for CHWs when delivering home care in rural areas in South Africa. A single case study was performed, mapping CHWs workflow and investigating where and when CHW can be supported by mHealth services. Despite the very positive feedback from the CHWs and the fact that the studied mHealth solutions appears to support the majority of the important activities in the CHWs work process, the application is no longer in use. Financial and strategic decisions are behind the discontinuation of the project, further stressing the importance of taking all socio-technical dimensions into account when evaluating success or failure of implementation projects.


Assuntos
Telemedicina , Fluxo de Trabalho , Agentes Comunitários de Saúde , Assistência à Saúde , Humanos , África do Sul
11.
Stud Health Technol Inform ; 265: 195-200, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431598

RESUMO

Community health workers, led by trained nurses who are linked to a health facility are well positioned to play an important role in improving health of the communities in low and middle-income countries. The South African Department of Health has implemented various mobile health programmes to improve community-based services. This paper presents a component of a study that evaluates mHealth interventions in South Africa. The study was conducted in Pretoria urban and semi-urban areas, with the aim of understanding how community health workers experience mHealth technologies. Three focus group interviews were conducted and data analysis followed Thorne Interpretive Description framework. An overarching theme was that the mHealth application provided clinical content that empowered community health workers to develop confidence, higher efficacy, independent decisions making and experience higher social standing with their clients. This in turn, translated into informed clients. There is evidence of strengthened capacity in the use of mHealth technology and application of knowledge to provide an engaged client care. Functionalities in the application allowed timely exchange of information and decision support.


Assuntos
Fortalecimento Institucional , Telemedicina , Agentes Comunitários de Saúde , Humanos , Renda , África do Sul
13.
Occup Ther Int ; 2019: 1201689, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467499

RESUMO

Background: In the South African context, there are no specific guidelines regarding how to prepare and support adolescents for the transition from a health care to a high school setting post TBI. This raises questions about the relevance and responsiveness of the current transition practices in occupational therapy in terms of adequately preparing and supporting these adolescents to participate in school and hence exercise their right to a quality education. Method: This study explored adolescents and other key role players' perspectives on and experiences of the high school transition (i.e., school reentry and continued school participation) post TBI. It was anticipated that this would provide an increased understanding of the enablers and barriers to high school reentry and participation post TBI. This served as a basis to explore the main aim of this study which was to help occupational therapists identify where efforts in terms of service delivery are needed. This study was situated in the interpretivist qualitative paradigm and used a multicase study design, which included semistructured interviews with eight adolescent learners with TBI, their primary caregivers, teachers, and principals as well as observations and documentation review. Results: This paper will focus on a central theme in the research, namely, the nature and extent of support needed to facilitate the high school transition of adolescents with TBI within a developing context. Similar to the findings of studies conducted in developed contexts, participants highlighted that they felt that adolescents need support at various stages of the school transition. Participants further alluded to support that should be collaborative, coordinated, flexible, and monitored to ensure it is relevant and responsive to these adolescents' changing needs. Conclusion: The study findings conclude that occupational therapists have a crucial role in fostering an enabling environment (directly and indirectly) through fulfilling various roles including that of a facilitator, intermediary, coach, collaborator, supporter, and advocator.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Terapia Ocupacional , Instituições Acadêmicas , Ajustamento Social , Estudantes/psicologia , Adolescente , Lesões Encefálicas Traumáticas/psicologia , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Apoio Social , África do Sul , Adulto Jovem
14.
Environ Monit Assess ; 191(8): 500, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31321551

RESUMO

The placenta plays an important role in mediating the effect of maternal metal exposure on fetal development, acting as both barrier and transporter. Term-placenta metal levels serve as an informative snapshot of maternal/fetal exposure during pregnancy and could be used to predict offspring short- and long-term health outcomes. Here, we measured term-placenta metal levels of 11 metals in 42 placentas from the Soweto First 1000 days cohort (S1000, Soweto-Johannesburg, SA). We compared these placental metal concentrations with previously reported global cohort measurements to determine whether this cohort is at increased risk of exposure. Placental metals were tested for correlations to understand potential interactions between metals. Since these samples are from a birth cohort study, we also performed exploratory analyses to determine whether metal levels were associated with placenta and birth outcomes. Most S1000 placental metal levels were similar to other cohorts; however, cadmium (Cd) levels up to 50-fold lower, and essential elements nickel (Ni) and chromium (Cr) level up to 6- and 16-fold lower, respectively. Cd, Se, and Ni were associated with placenta and birth outcomes. Studies are ongoing to examine underlying mechanisms and how these developmental differences affect long-term health.


Assuntos
Monitoramento Ambiental/métodos , Exposição Materna , Metais Pesados/análise , Placenta/química , Oligoelementos/análise , Estudos de Coortes , Feminino , Humanos , Masculino , Gravidez , Resultado da Gravidez , África do Sul
15.
Afr J AIDS Res ; 18(2): 148-157, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282300

RESUMO

The aim of this study was to explore the perceptions of school principals and the experiences of disclosure amongst teachers living with HIV. Due to HIV/AIDS-related stigma being prevalent in many societies today, many infected people would rather not disclose their status than deal with negative labelling and stereotyping. This study utilised narrative inquiry as a qualitative research design that is known to be a way of understanding experiences. Data was elicited via narrative interviews from a purposeful sample of ten principals and eight teachers living with HIV who were selected through network sampling from Gauteng public urban schools. The study found that stigma, fear of job loss and gossip deterred teachers from disclosing their HIV status. In some instances, they disclosed due to needing support, which principals provided in the form of counselling, and also to explain absenteeism. Although principals supported disclosure of teachers' HIV status so that they could initiate care, confidentiality concerns showed that disclosure could further worsen stigma and the culture of discrimination and moral judgement that teachers living with HIV faced. The study recommends on-going development of caring relationships to deepen the understanding of the experiences of teachers living with HIV. Nondisclosure of HIV status stands in the way of building caring relationships between teachers and principals. There is still a need to create safe, supportive and empathetic environments in schools for teachers living with HIV.


Assuntos
Infecções por HIV/psicologia , Percepção , Professores Escolares/psicologia , Adulto , Aconselhamento , Revelação , Medo , Feminino , HIV/fisiologia , Infecções por HIV/virologia , Humanos , Masculino , Pesquisa Qualitativa , Instituições Acadêmicas , Estigma Social , África do Sul , Estereotipagem , Adulto Jovem
16.
Afr J AIDS Res ; 18(2): 158-167, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282301

RESUMO

The study explored constructions of sexuality among young people of Venda in Limpopo, South Africa, and cultural practices that can be used to develop context-specific HIV prevention programmes. HIV prevention can be promoted by including some cultural practices in prevention programmes and changing some aspects of culture that may contribute negatively to health. Six focus group discussions were held with school-going young people (Grades 10 to 12) in urban and rural areas to explore their constructions of sexuality and HIV risk. Four focus group discussions were held with community leaders in the same areas to explore their constructions of young people's sexuality and cultural practices relevant to HIV prevention. Through discourse analysis, the following dominant discourses that influence young people's sexual risk behaviour were identified: rite of passage, the male sexual drive discourse (sex is natural and unavoidable); discourse of hegemonic masculinity (sex to prove masculinity); sex as a commodity; non-adherence to cultural practices; and HIV is normalised (AIDS is like flu). Some alternative constructions and shifts in gender norms were noticed, especially among female participants. The constructions of young people were not culture-specific but similar to those identified in other South African cultures. Community leaders identified a few cultural practices that could be considered in HIV prevention, for example, reinstating the rite of passage to provide age-appropriate sex and HIV education (behavioural intervention), and promoting traditional male circumcision (biological intervention). Cultural practices that contribute negatively to health should be challenged such as current constructions of gender roles (masculinity and femininity) and the practice that parents do not talk to young people about sex (both structural interventions).


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Sexualidade , Adolescente , Circuncisão Masculina , Feminino , Feminilidade , Grupos Focais/estatística & dados numéricos , Infecções por HIV/epidemiologia , Humanos , Masculino , Masculinidade , Fatores de Risco , Assunção de Riscos , Instituições Acadêmicas , Comportamento Sexual , África do Sul/epidemiologia
17.
Afr J AIDS Res ; 18(2): 104-114, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282302

RESUMO

In South Africa, African traditional healers and biomedical practitioners play important roles in the management of HIV and AIDS, but provide healthcare services in isolation of each other, despite legislative recognition of both types of healing. An interpretive, qualitative research approach was employed to elicit the views of both groups regarding the feasibility of collaboration. Semi-structured interviews were conducted with a sample of 20 participants with 10 persons from each group. Key findings were that African traditional healers referred their patients to hospitals but never received referrals from biomedical health care practitioners. The traditional healers took precautions to avoid drug interactions between their medicines and antiretrovirals (ARVs). Biomedical healthcare practitioners recommended that traditional medicine only be used externally to avoid interaction with ARVs. Lack of shared knowledge, poor dosages and medical complications due to the use of African traditional medicine were viewed as threats to the collaboration between the two groups, while open communication, research into the efficacy, scientific administration and proper dosages of African traditional medicine were articulated as facilitating factors. The main conclusion was that biomedical practitioners, traditional healers and government officials responsible for formulating healthcare policies need to be involved in devising a framework that would facilitate ways of encouraging collaboration between these two healthcare systems.


Assuntos
Síndrome de Imunodeficiência Adquirida/terapia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/terapia , Medicina Tradicional Africana , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Assistência à Saúde , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Política de Saúde , Serviços de Saúde , Humanos , Masculino , Pesquisa Qualitativa , Encaminhamento e Consulta , África do Sul , Terapias Espirituais , Adulto Jovem
18.
Afr J AIDS Res ; 18(2): 115-122, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282305

RESUMO

HIV status awareness is a rate limiting step in HIV treatment and prevention initiatives aimed at addressing the global HIV epidemic. Uptake of HIV testing remains suboptimal despite global campaigns aimed at improving uptake. HIV self-testing (HIVST) displays the potential to increase uptake of HIV testing in public health care facilities, which are the main access points for HIV testing, but evidence to support this notion is limited. Therefore, this study determined the factors that influence the feasibility of introducing HIVST into public facilities in KwaZulu-Natal, South Africa, through a mixed method crossover study design, implemented among 40 consenting adults who were either regular HIV testers or HIV testing naïve. Qualitative assessments were conducted using a topic guide centred on the feasibility of HIVST. Usability of HIVST was quantitatively assessed by means of a HIVST usability assessment checklist. Technical, environmental and economic factors were found to influence HIVST feasibility. The majority of participants were able to conduct unsupervised HIVST but training may be required for those unable to follow instructions. Accessibility of HIVST was associated with affordability and convenience. Environmental factors such as storage and location to perform the test and a disposal kit require further consideration in limited resource settings due to lack of privacy and confidentiality. While we demonstrated that HIVST is feasible, and identified factors that may influence its feasibility, these factors require further consideration in primary health care facilities in resource limited settings prior to scale-up.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/psicologia , Adolescente , Adulto , Estudos de Coortes , Estudos de Viabilidade , Feminino , HIV/isolamento & purificação , Infecções por HIV/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Distribuição Aleatória , População Rural/estatística & dados numéricos , África do Sul , População Urbana/estatística & dados numéricos , Adulto Jovem
19.
BMC Public Health ; 19(1): 898, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286953

RESUMO

BACKGROUND: HIV diagnosis is a critical step in linking HIV-infected individuals to care and treatment and linking HIV-uninfected persons to prevention services. However, the uptake of HIV testing remains low in many countries. HIV self-screening (HIVSS) is acceptable to adults, but there is limited data on HIVSS feasibility in community programmes. This study aimed to evaluate the feasibility of HIVSS in South Africa. METHODS: We conducted a prospective study that enrolled participants through mobile site, homebased, workplace and sex worker programmes in two townships from May to November 2017. Following an information session on HIVSS, interested participants were offered one of three methods of HIVSS testing: supervised, semi-supervised, and unsupervised. Participants who opted for unsupervised testing and those who tested HIV positive after semi- or supervised HIVSS were followed up telephonically or with a home visit one week after receipt of the test kit to confirm results and linkages to care. Follow-up visits were concluded when the participant indicated that they had used the kit or had accessed a confirmatory HIV test. RESULTS: Of the 2061 people approached, 88.2% (1818/2061) received HIV testing information. Of this group, 89% (1618/1818) were enrolled in the study and 70.0% (1133/1618) were tested for HIV with the kit. The median age was 28 (IQR:23-33) years with an even gender distribution. Of those enrolled, 43.0% (696/1618) were identified through homebased outreach, 42.5% (687/1618) through mobile sites, 7.3% (118/1618) at their workplace and 7.2% (117/1618) from sex worker programmes. A total of 68.7% (1110/1616) selected unsupervised HIVSS, whereas 6.3% (101/1616) opted for semi-supervised and 25.0% ((405/1616) chose supervised HIVSS. Overall, the HIV prevalence using the HIVSS test was 8.2% (93/1129). Of those newly diagnosed with HIV, 16% (12/75) were initiated on ART. Almost half (48.0%; 543/1131) of those tested were linked to a primary HIV test as follows: supervised (85.2%; 336/394); semi-supervised (93.8%; 91/97) and unsupervised (18.1%; 116/640). CONCLUSION: Unsupervised HIVSS was by far the most selected and utilised HIVSS method. Linkages to primary and confirmatory testing for the unsupervised HIVSS and further care were low, despite home visits and telephonic reminders.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autocuidado/métodos , Testes Sorológicos/métodos , Adulto , Estudos de Viabilidade , Feminino , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Programas de Rastreamento/psicologia , Prevalência , Estudos Prospectivos , Autocuidado/psicologia , Testes Sorológicos/psicologia , Profissionais do Sexo , África do Sul/epidemiologia , Adulto Jovem
20.
BMC Public Health ; 19(1): 866, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269939

RESUMO

BACKGROUND: There is no population based occupational health surveillance system in South Africa, thus mortality data may be a cost effective means of monitoring trends and possible associations with occupation. The aim of this study was to use deaths due to pneumoconiosis (a known occupational disease) to determine if the South African mortality data are a valid data source for occupational health surveillance in South Africa. METHODS: Proportions of complete occupation and industry information for the years 2006-2015 were calculated for working age and retired adults. Deaths due to pneumoconiosis were identified in the data set and mortality odds ratios calculated for specific occupations and industry in reference to those who reported being unemployed using logistic regression. RESULTS: Only 16.1% of death notifications provided a usual occupation despite 43.1% of the population being employed in the year. The MORs for occupation provided significant increased odds of pneumoconiosis for miners (9.04), those involved in manufacturing (4.77), engineers and machinery mechanics (6.85). Along with these jobs the Mining (9.8), Manufacture (2.2) and Maintenance and repair industries (6.0) have significantly increased odds of pneumoconiosis deaths. The data can be said to provide a useful source of occupational disease information for surveillance where active surveillance systems do not exist. CONCLUSION: The findings indicate valid associations were found between occupational disease and expected jobs and industry. The most useful data are from 2013 onwards due to more detailed coding of occupation and industry.


Assuntos
Indústrias/estatística & dados numéricos , Doenças Profissionais/mortalidade , Ocupações/estatística & dados numéricos , Pneumoconiose/mortalidade , Vigilância da População , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Reprodutibilidade dos Testes , África do Sul/epidemiologia
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