Case-crossover study for the association between increased hospital admissions for respiratory diseases and the increase in atmospheric PM2.5 and PM2.5-bound trace elements in Pretoria, South Africa.

Outdoor PM2.5 was sampled in Pretoria, 18 April 2017 to 28 February 2020. A case-crossover epidemiology study was associated for increased PM2.5 and trace elements with increased hospital admissions for respiratory disorders (J00-J99). The results included a significant increase in hospital admissions, with total PM2.5 of 2.7% (95% CI: 0.6, 4.9) per 10 µg·m-3 increase. For the trace elements, Ca of 4.0% (95% CI: 1.4%-6.8%), Cl of 0.7% (95% CI: 0.0%-1.4%), Fe of 3.3% (95% CI: 0.5%-6.1%), K of 1.8% (95% CI: 0.2-3.5) and Si of 1.3% (95% CI: 0.1%-2.5%). When controlling for PM2.5, only Ca of 3.2% (95% CI: 0.3, 6.1) and within the 0-14 age group by 5.2% (95% CI: 1.5, 9.1). Controlling for a co-pollutant that is highly correlated with PM2.5 does reduce overestimation, but further studies should include deposition rates and parallel sampling analysis.

Curricular Renewal at the Southern Tip of Africa: The 2016 Veterinary Curriculum at the University of Pretoria.

Four years after the institution of a new curriculum at the University of Pretoria's Faculty of Veterinary Science, a second major curricular renewal was initiated as a result of several pressing drivers, many of which were unique to the national and institutional context. During the project, South African higher education was disrupted by student protests prompted by financial pressures on students, the overt colonial structure of higher education, and the need to accelerate transformation of the sector. A structured curricular renewal process was followed, including the laying down of the principles, the structuring the macro-curriculum as a story, the design of a meso- and micro-curriculum, and the mapping of the curriculum to Day One outcomes. The resulting program is a 6-year bachelor's degree with a blend of discipline and species modules, with the first cohort graduating in 2016. There is a strong focus on skills embodied in a 62-week experiential component, managed using a unique custom-designed online platform for booking placements, documenting exposure, assessing competency, and providing feedback to students. The experiential training includes a large elective component. Several causes of loss of impetus during the process are discussed and proposals are made for avoiding these. The value of accreditation as a driver and a source of inputs is evident. The process has succeeded in producing a significantly reshaped curriculum that has been well received by external stakeholders.

Direct radiative forcing of urban aerosols over Pretoria (25.75°S, 28.28°E) using AERONET Sunphotometer data: first scientific results and environmental impact.

The present study uses the data collected from Cimel Sunphotometer of Aerosol Robotic Network (AERONET) for the period from January to December, 2012 over an urban site, Pretoria (PTR; 25.75°S, 28.28°E, 1449 m above sea level), South Africa. We found that monthly mean aerosol optical depth (AOD, τ(a)) exhibits two maxima that occurred in summer (February) and winter (August) having values of 0.36 ± 0.19 and 0.25 ± 0.14, respectively, high-to-moderate values in spring and thereafter, decreases from autumn with a minima in early winter (June) 0.12 ± 0.07. The Angstrom exponents (α440-870) likewise, have its peak in summer (January) 1.70 ± 0.21 and lowest in early winter (June) 1.38 ± 0.26, while the columnar water vapor (CWV) followed AOD pattern with high values (summer) at the beginning of the year (February, 2.10 ± 0.37 cm) and low values (winter) in the middle of the year (July, 0.66 ± 0.21 cm). The volume size distribution (VSD) in the fine-mode is higher in the summer and spring seasons, whereas in the coarse mode the VSD is higher in the winter and lower in the summer due to the hygroscopic growth of aerosol particles. The single scattering albedo (SSA) ranged from 0.85 to 0.96 at 440 nm over PTR for the entire study period. The averaged aerosol radiative forcing (ARF) computed using SBDART model at the top of the atmosphere (TOA) was -8.78 ± 3.1 W/m², while at the surface it was -25.69 ± 8.1 W/m² leading to an atmospheric forcing of +16.91 ± 6.8 W/m², indicating significant heating of the atmosphere with a mean of 0.47K/day.

Selenium and other heavy metal levels in different rice brands commonly consumed in Pretoria, South Africa.

For centuries, rice has been a dietary staple food partially due to its accessibility, affordability, and nutritional content. However, it has been documented that plants can bioaccumulate trace elements from soil and store them in their tissues therefore necessitating monitoring of its nutritional quality. The current study investigated the Selenium and heavy metal contents of various brands of rice obtained from different retail stores in Pretoria, South Africa. The analysis was carried out using different rice samples and different methods/stages of cooking rice including the analysis of rinsed rice water (RW), raw rice (RR), cooked rice (CR), and cooked rice water (CW), for trace elements content using the Inductive Couple Plasma Mass Spectrometry. The results revealed that the Se content ranged from 0.013 ± 0.01 mg/kg - 0.089 ± 0.06 mg/kg in RR, 0.013 ± 0.01 mg/kg - 0.046 ± 0.01 mg/kg in CR, 0.01 ± 0.01mg/kg- 0.028 ± 0.00 mg/kg in RW and 0.01 ± 0.01 mg/kg - 0.048 ± 0.01 mg/kg in CW. The calculated estimated dietary intake (EDI) of Se was recorded as follows; raw rice (7.06 × 10-5 mg/day), cooked rice (5.01 × 10-5 mg/day), water from cooked rice (4.54 × 10-5 mg/day) and rinsed water of raw rice (3.97 × 10-5 mg/day). The concentrations of all other heavy metals measured were within the WHO-recommended limits. The HQ for all the trace metals in all the samples did not exceed one, implying that there is no health risk from trace metals analysed in this study from the consumption of the rice brands used in this study. The results of this study demonstrated that reliance on rice alone for the supply of Se may be inadequate owing to the values obtained in our study. Constant monitoring of the nutritional contents of food products may be required to improve the overall nutritional well-being of the consumers.

Molecular epidemiology of multidrug-resistant Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli outbreak among neonates in Tembisa hospital, South Africa.

Background: An outbreak of multidrug-resistant Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacae infections in a neonatal ward within a tertiary hospital in South Africa resulted in the mortality of 10 patients within six months. In this work, the genomic epidemiology of and the molecular factors mediating this outbreak were investigated. Methods: Bacterial cultures obtained from clinical samples collected from the infected neonates underwent phenotypic and molecular analyses to determine their species, sensitivity to antibiotics, production of carbapenemases, complete resistance genes profile, clonality, epidemiology, and evolutionary relationships. Mobile genetic elements flanking the resistance genes and facilitating their spread were also characterized. Results: The outbreak was centered in two major wards and affected mainly neonates between September 2019 and March 2020. Most isolates (n = 27 isolates) were K. pneumoniae while both E. coli and E. cloacae had three isolates each. Notably, 33/34 isolates were multidrug resistant (MDR), with 30 being resistant to at least four drug classes. All the isolates were carbapenemase-positive, but four bla OXA-48 isolates were susceptible to carbapenems. Bla NDM-1 (n = 13) and bla OXA-48/181 (n = 15) were respectively found on IS91 and IS6-like IS26 composite transposons in the isolates alongside several other resistance genes. The repertoire of resistance and virulence genes, insertion sequences, and plasmid replicon types in the strains explains their virulence, resistance, and quick dissemination among the neonates. Conclusions: The outbreak of fatal MDR infections in the neonatal wards were mediated by clonal (vertical) and horizontal (plasmid-mediated) spread of resistant and virulent strains (and genes) that have been also circulating locally and globally.

Level of patient safety culture among public healthcare professionals in Pretoria.

BACKGROUND: Patient safety culture (PSC) norms set within an organisation prevent harm during medical care. This study assessed the level of PSC among public healthcare professionals (HCPs) in Pretoria, South Africa. METHODS: A multi-centre cross-sectional study conducted in three hospitals and 25 clinics in regions 1 and 2 of Pretoria, using a self-administered questionnaire adapted from the Hospital Survey on Patient Safety Culture. Using the Raosoft online sample size formula, from 1238 public HCPs identified, the sample size was calculated at 294; this expanded to 319 as a result of respondents' willingness to participate in the study. RESULTS: Of the 319 respondents with a mean age of 39.9 years, the minimum and maximum ages were 22 and 66 years, respectively. The age group of 30-39 years had the highest participation rate (17.6%). Most respondents (41.1%) came from the Odi district hospital and there were more women (78.1%) and nurses (49.2%). Positive attitudes were found for all PSC components, with staff education and training scoring highest (98.7%). Patient safety culture received a satisfactory rating from HCPs from the targeted facilities. CONCLUSION: This study showed that public HCPs in Pretoria's regions 1 and 2 have a good PSC, particularly among nurses, professionals with more experience, and at primary care level.Contribution: To maintain or increase awareness of this concept among HCPs, the study advocates a PSC programme as well as ongoing education that can be supported by district and facility managers.

Association Between Weather Parameters and SARS-CoV-2 Confirmed Cases in Two South African Cities.

Several approaches have been used in the race against time to mitigate the spread and impact of COVID-19. In this study, we investigated the role of temperature, relative humidity, and particulate matter in the spread of COVID-19 cases within two densely populated cities of South Africa-Pretoria and Cape Town. The role of different levels of COVID-19 restrictions in the air pollution levels, obtained from the Purple Air Network, of the two cities were also considered. Our results suggest that 26.73% and 43.66% reduction in PM2.5 levels were observed in Cape Town and Pretoria respectively for no lockdown (Level 0) to the strictest lockdown level (Level 5). Furthermore, our results showed a significant relationship between particulate matter and COVID-19 in the two cities. Particulate matter was found to be a good predictor, based on the significance of causality test, of COVID-19 cases in Pretoria with a lag of 7 days and more. This suggests that the effect of particulate matter on the number of cases can be felt after 7 days and beyond in Pretoria.

Multiple Novel Human Norovirus Recombinants Identified in Wastewater in Pretoria, South Africa by Next-Generation Sequencing.

The genogroup II genotype 4 (GII.4) noroviruses are a major cause of viral gastroenteritis. Since the emergence of the Sydney_2012 variant, no novel norovirus GII.4 variants have been reported. The high diversity of noroviruses and periodic emergence of novel strains necessitates continuous global surveillance. The aim of this study was to assess the diversity of noroviruses in selected wastewater samples from Pretoria, South Africa (SA) using amplicon-based next-generation sequencing (NGS). Between June 2018 and August 2020, 200 raw sewage and final effluent samples were collected fortnightly from two wastewater treatment plants in Pretoria. Viruses were recovered using skimmed milk flocculation and glass wool adsorption-elution virus recovery methods and screened for noroviruses using a one-step real-time reverse-transcription PCR (RT-PCR). The norovirus BC genotyping region (570-579 bp) was amplified from detected norovirus strains and subjected to Illumina MiSeq NGS. Noroviruses were detected in 81% (162/200) of samples. The majority (89%, 89/100) of raw sewage samples were positive for at least one norovirus, compared with 73% (73/100) of final effluent samples. Overall, a total of 89 different GI and GII RdRp-capsid combinations were identified, including 51 putative novel recombinants, 34 previously reported RdRp-capsid combinations, one emerging novel recombinant and three Sanger-sequencing confirmed novel recombinants.

Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria.

BACKGROUND: The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01 January 2020 to 30 June 2020. METHODS: A cross-sectional study using a piloted and researcher assistant-administered questionnaire. RESULTS: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30-39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12-23 months. From participants' responses, it seems that Etonogestrel implants may be offered from as early as 15-20 years of age. CONCLUSION: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.

Awareness of health risks associated with smokeless tobacco use among users in Pretoria.

BACKGROUND: Smokeless tobacco (ST) refers to all tobacco-containing products that are not smoked but rather consumed through other means. Contrary to the popular belief that ST products are safe, the use of such products exposes users to health risks. To assess the awareness of health risks associated with ST use among users in a Pretoria community, the study was conducted in Ramotse community, located in Tshwane region 2, Gauteng, South Africa. METHODS: This was a cross-sectional design, using a piloted, structured and self-administered questionnaire. RESULTS: Of 479 participants with a mean age of 43 years (ranging from 18 to 89 years), most were in the age group 30-39 years (148; 31.6%), followed by ≥ 50 years (138; 29.4%). There were more females (371; 77.5%), more unemployed (263; 54.9%), married (236; 49.7%), had reached the secondary level of education (270; 56.4%), did not have any chronic illness (274; 57.2%), used snuff by nose (338; 70.6%), and were unaware of health risks associated with ST use (452; 94.4%). CONCLUSION: This study has demonstrated a poor awareness of health risks associated with ST use among the users in a Pretoria community. As a result, health education at various levels of the community (clinic, schools, ward-based outreach team or WBOT, etc.) could be one strategy for resolving the problem.

Temporal variation in suicide in peri-urban Pretoria.

BACKGROUND: Suicide is a public health problem, and the third major cause of death in Indian, black and mixed race groups. In whites suicide is the second cause of death. The patterns of suicide vary by time of day, day of the week, month of the year and seasons. As a result of limited and inaccurate data, these variations have not been fully examined in the developing world. This study investigated the diurnality and seasonality of suicide in peri-urban Pretoria, as opposed to studies conducted previously in the country's metropolitan. METHODS: A retrospective analysis of suicides recorded between 2007 and 2019 was undertaken. Data were extracted from the forensic pathology department's database (university mortuary). RESULTS: Of the 1515 cases of suicides examined, majority were black Africans (95.9%), male (83.9%), aged 21-40 years (50.5%). Hanging was the most common method of suicide irrespective of demographics (72.8%). Diurnal suicide variations were distinct for men and women, occurring at (16:00-20:00) and (08:00-12:00), respectively. Suicide peaked on days preceding and after the weekend (Mondays and Fridays) and in warmer seasons (summer and spring)Conclusion: The overall patterns of suicide in peri-urban Pretoria, mimic local and global trends with regard to methods, demographics and temporal characteristics. The underlying mechanism for these trends is unclear requiring in-depth investigation in order to develop appropriate interventions.

Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria

The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01January 2020 to 30 June 2020.Methods: A cross-sectional study using a piloted and researcher assistant-administered questionnaire.Results: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30­39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12­23 months. From participants' responses, it seems that Etonogestrel implants may be offered from as early as 15­20 years of age. Conclusion: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.Keywords: early removal; etonogestrel; subcutaneous contraceptive; implant; Pretoria; community health centre; weight gain; vaginal bleeding.

Prevalence of geophagia and its contributing factors among pregnant women at Dr. George Mukhari Academic Hospital, Pretoria.

INTRODUCTION: Geophagia is very common among pregnant women, particularly in Africa. There are many reasons given for geophagia such as cultural, medicinal and religious, making it an acceptable norm regardless of health risks involved. OBJECTIVES: The study explored prevalence and factors influencing geophagia among women visiting an antenatal clinic in Pretoria. METHODS: A quantitative survey was done on a convenience sample of 597 pregnant women and structured interviews conducted. Statistical analysis was done using simple percentage and interview data analyzed using Epi Info statistical software. RESULTS: Geophagia was reported by 54.0% of the women (n=323) and of these, 75.2% (n=243) ate at least 3 teaspoons per day. Reasons for the practice ranged from simple unexplained craving to belief that soil acts as an iron supplement. The study revealed that education levels did not act as a contributing factor as both literate and illiterate women were consumers. Partners of consumers played a key role in influencing the practice as most consumers were not married. CONCLUSION: Geophagia is practiced by a considerable proportion of pregnant women in this area. Greater vigilance may be needed as part of the antenatal classes to avoid potentially harmful effects of the habit.

Investigating the psychometric properties of the Rosenberg Self-Esteem scale for South African residents of Greater Pretoria.

Interviewers administered the Rosenberg Self-Esteem scale (RSES) to five groups of Black (formal township and informal settlement), White, Indian, and mixed race adult residents of Greater Pretoria. The results demonstrated that the RSES was psychometrically sound for the five groups. The minimal effects of sociodemographic characteristics on global self-esteem showed that the RSES and its two dimensions, self-competence (SC) and self-liking (SL), were suitable in this setting. All five groups scored above the theoretical midpoint of the RSES, indicating that generally positive self-evaluations appear to be universal. The relationships between positively and negatively worded items, SC, and SL attested to the following: internal structure reliability, congruence between positive and negative items, no negative biases in response, and concordance between SC and SL dimensions. The significant differences between informal settlement residents and the other four groups on global self-esteem, positively and negatively worded items, and SC and SL were possibly due to physiological needs taking precedence over higher order needs.

South African research into AIDS "cure" severely criticised.

PIP: In South Africa, claims that the drug Virodene P058 inhibits progression of HIV infection have been condemned. The claims were forwarded by a team from Pretoria University which conducted its experiments without obtaining the required permission, demonstrated a lack of specific scientific skill, lacked a proper control group, and worked in secret. Virodene P058 contains diethylformamide, a toxic industrial solvent which has not been shown to inhibit HIV protease. The researchers also garnered criticism for bypassing normal procedures and presenting their results directly to the minister of health in a bid to obtain funding. Critics also voiced concern about the creation of a private company by one of the researchers. The research team, which has threatened to take legal action against the team of experts convened to look into the matter, faces additional charges of professional negligence or misconduct.^ieng

Genetic diversity of rotavirus genome segment 6 (encoding VP6) in Pretoria, South Africa.

BACKGROUND: Rotavirus viral protein 6 (VP6), encoded by genome segment (GS) 6, is the primary target for rotavirus diagnosis by serological and some molecular techniques. Selected full length nucleotide sequences of GS 6 of rotavirus strains from South Africa were sequenced and analysed to determine genetic diversity and variations within the circulating rotaviruses. FINDINGS: The VP6 amplicons were sequenced using the Sanger ABI 3130xl. Phylogenetic and pairwise analysis revealed that the VP6 genes of the study strains belonged to two different VP6 [I] genotypes. Five sequences were assigned genotype I1 and seven as genotype I2. Comparison of the group specific antigenic regions of the South African strains to the reference strains, shows that the South African VP6 sequences belonging to the VP6 genotype I2 were highly conserved, with only two amino acids changes at positions 239 (T>N) and 261(I>V). On the other hand, South African VP6 sequences belonging to I1 genotypes revealed several amino acid variations mostly within the antigenic region III. CONCLUSIONS: Rotavirus strains with I1 and I2 genotype are predominantly circulating within the South African communities of which the later seems to be more conserved within the antigenic regions. The observed genetic variations observed within GS 6 of rotaviruses analysed in the current study are unlikely to impact negatively on the performance of the current VP6-based detection methods. Nevertheless, investigators should continually consider this diversity and adapt the primer design for the detection and characterization of the VP6 gene accordingly.