Forensic human identification: retrospective investigation of anthropological assessments in the Western Cape, South Africa.

The identification of unknown persons, particularly those who are decomposed or burnt, is a global challenge. Forensic Anthropology Cape Town (FACT) is a service provider that assists the South African state with the identification of human remains. However, empirical data pertaining to anthropologically analysed forensic cases in the Western Cape Province of South Africa are lacking. Therefore, anthropological data pertaining to the forensic cases submitted to FACT between 2006 and 2018 from Forensic Pathology Services were retrospectively reviewed (n = 172). This study also sought to assess demographic, traumatic and pathological factors that impacted successful identification. Most decedents were male (67%) and older than 35 years (54%). While ante-mortem trauma was observed in 41% of decedents, the lack of medical records on ante-mortem injuries hindered the use of this information for identification. Positive identifications were reached for 37% of decedents, and of these, anthropological estimations were correct in 98% of cases for sex, 84% of cases for age at death and 100% of cases for stature. Considering globally accepted accuracies of 70-80%, these estimations were considered highly accurate, suggesting the anthropological methods used are suited to the population. However, 63% of cases remained unidentified, and this study showed that skeletal completeness and pathological conditions were the main factors that hindered demographic estimations. Lastly, not all unidentified bodies in the province were referred to FACT; given the highly accurate estimations, these data advocate for the routine, if not mandatory, use of forensic anthropology services for skeletonised remains in South Africa, with the overall purpose of positively impacting human identification. To improve identification rates globally, these data highlight the value of retrospective and region-specific studies to identify strengths and weaknesses in the system.

"Asthma is a very bully disease" - patient experiences of living with chronic respiratory diseases in Cape Town, South Africa.

BACKGROUND: Chronic respiratory diseases are common in Cape Town, South Africa. Yet the experiences of how adults with these conditions, such as asthma or COPD (chronic obstructive pulmonary disease), negotiate the health system are poorly understood. Qualitative methodology lends itself to investigate this question. AIM OF STUDY: To explore the "emic" experiences of adults with CRDs in Cape Town when they were negotiating the health system using semi-structured interviews. METHODS: Interviews were conducted following informed consent with purposively sampled adults who had attended public hospitals in Cape Town with chronic respiratory disease flare-ups. This work was nested in the quantitative "Diagnosing Airways Disease" study. The topic guide explored patients' experiences of accessing healthcare including receiving and interpretations of the diagnosis and management, and impacts on daily life. Interviews were conducted in Afrikaans, isiXhosa, or English; transcribed, and translated into English and thematically analysed until saturation. RESULTS: Thirty-two interviews (16 in Afrikaans, 8 in isiXhosa, 8 in English) were completed in 2022. 17 women and 15 men participated. Most participants were older than 50 years (25/32), and most were unemployed (13/32) or retired (11/32). The identified themes were: Perceived causes of illness; experiences of healthcare; perceived risks and barriers when accessing healthcare; and impact on earnings. The perceived causes of their illness and risks were structural, and included air pollution, poor quality housing, occupational exposures, limited healthcare services, and fear of violence. These factors led to self-treatment, sharing of medicines, and delay in receiving a diagnosis. Many paid privately for treatments or services to overcome identified shortcomings of the public healthcare system, and many reported additional significant indirect costs. Being ill had a profound impact on income. The identified themes were explored through the lens of "structural violence", where "social structures stop individuals … from reaching their full potential" (Galtung, 1969). CONCLUSION: In Cape Town structural elements such as stretched healthcare professionals, insufficiently enforced policies on e.g., housing or work-place exposures, poverty and crime made it difficult for participants to successfully navigate their illness experience. It forced some to pay out of pocket to receive perceived better healthcare privately.

Child and adolescent mortality associated with pesticide toxicity in Cape Town, South Africa, 2010-2019: a retrospective case review.

BACKGROUND: Poisoning of children after exposure to pesticides is a major public health concern, particularly in countries with poorer urban populations, such as South Africa. This may stem from the illegal distribution and domestic use of street pesticides, which are highly hazardous agricultural pesticides. The aim of this study was to profile paediatric deaths due to acute pesticide poisoning in the west-metropole of Cape Town, South Africa; to identify whether the active ingredients were highly hazardous pesticides according to the FAO and WHO; and to inform policy and public health interventions to prevent future exposures and mortality. METHODS: A retrospective and descriptive analysis of forensic post-mortem records (2010 to 2019) was conducted to identify cases of paediatric deaths (< 18 years old) in the west metropole of Cape Town, involving pesticide poisoning admitted to the Salt River mortuary (one out of 16 mortuaries in the Western Cape province). Demographic, circumstantial, autopsy, and toxicological information was captured. Descriptive statistics, together with chi-square tests, Fisher's probability tests, and Mann-Whitney U tests were used to analyse the data. RESULTS: In total, 54 paediatric pesticide deaths were identified, including 22 (40.7%) males and 32 (59.3%) females, out of 5,181 paediatric unnatural deaths admitted over the 10-year period. The median age of the decedents was 8.3 years (range: 1 day to 17.9 years), with the majority under five years (42.6%) or between 15 and 18 years old (40.7%). All incidents occurred in peri-urban areas of Cape Town, with most individuals being admitted to hospital (88.9%) for a median survival time of 4.8 h. Toxicological analysis was requested in 50 cases (92.6%) with the organophosphate pesticides terbufos (n = 29), methamidophos (n = 2) and diazinon (n = 2) detected most frequently. Adolescent (15-18 years) suicides (29.6%) and accidental child deaths (< 4 years) (18.5%) were common. CONCLUSIONS: Terbufos and methamidophos are highly hazardous pesticide (HHP) active ingredients registered in South Africa for agricultural uses, yet commonly sold as street pesticides for domestic use in lower socioeconomic areas. Reducing access and availability of toxic pesticides, especially through the illegal selling of street pesticides, and providing low toxic alternatives to poorer communities, may support mortality reduction initiatives. Mortality and toxicology data provide important, often overlooked, surveillance tools for informing policy and public health interventions to reduce toxic pesticide harm in local communities.

Health Sciences students' experience of COVID-19 case management and contact tracing in Cape Town, South Africa.

BACKGROUND: COVID-19 has challenged health and higher education systems globally. Managing the epidemic in Cape Town, South Africa (SA), required partnerships with universities and setting up of de novo systems for mass case and contact tracing (C&CT). Health sciences, predominantly medical students, as well as social work and psychology students formed the core of this telephone-based work over the 18 months when SARS-CoV-2 caused severe disease. METHODS: This qualitative study aimed to elicit students' motivations for becoming involved in C&CT, their experiences, and recommendations for C&CT and curricula. After Cape Town's first COVID-19 wave, six on-line focus groups comprising 23 students were conducted, and a further four were conducted with 13 students after the second wave. As the researchers were predominantly educators previously involved in undergraduate health sciences education, the study's purpose was to reflect on students' experiences to make educational and health system recommendations. RESULTS: Students were largely motivated to mitigate the impact of the epidemic on society and support people affected by COVID-19, as well as hone their professional skills. While these motivations were realised, students also needed to learn new skills - to autonomously work remotely, using novel communication strategies to engage those affected and use virtual groups to connect with colleagues. They managed responsibilities within the healthcare systems that did not always work smoothly, distressed cases who were financially insecure, difficult employers, and language barriers. They were prepared through training, and supported by virtual, yet effective teamwork and debriefing opportunities. Although the work was sometimes physically and emotionally exhausting, students found the work personally meaningful. They embraced public health's role to protect population and individuals' health. CONCLUSION: New teaching and learning practices adopted due to Covid-19 lockdowns enabled this digital C&CT project. It facilitated students to become confident, work autonomously and navigate challenges they will encounter as young professionals. The programme demonstrated that novel opportunities for rich student learning, such as in telehealth, can be embedded into public health and clinical functions of health services in contexts such as in SA, deepening partnerships between the health services and universities, to mutual benefit.

Urban community gardens in Cape Town, South Africa: navigating land access and land tenure security.

Land tenure security continues to pose a significant challenge to the sustainability of urban community gardens in global South cities. However, a few studies have explored the mechanisms that urban gardeners employ to facilitate land access and variations in land tenure security arrangements made with land owners in South African cities. This paper employs a mixed-methods research approach involving quantitative and qualitative techniques to examine how urban community gardens access land and land tenure security arrangements thereof. The study is based on questionnaires, semi-structured interviews, and observations from 34 urban community food gardens in Cape Town selected through a combination of purposive and snowball sampling methods across selected low-income urban neighbourhoods. The findings reveal that although formalised land tenure security poses a sustainability threat to community gardens, perceived and de facto tenure present equally crucial forms of tenure which could be supported by state actors to promote urban agriculture. Reflecting on past efforts to formalise land tenure security, the article concludes that these efforts have failed due to poor coordination among government departments, and the complex and unclear processes of acquiring land. The paper recommends that while formalising land tenure arrangements may prove to be an effective solution, supporting institutions need to adopt a bottom-up approach to understand the gardener's needs and build on perceived and de facto land tenure security options to promote the sustainability of community gardening projects.

Flooding trends and their impacts on coastal communities of Western Cape Province, South Africa.

Climate change-induced extreme weather events have been at their worst increase in the past decade (2010-2020) across Africa and globally. This has proved disruptive to global socio-economic activities. One of the challenges that has been faced in this regard is the increased coastal flooding of cities. This study examined the trends and impacts of coastal flooding in the Western Cape province of South Africa. Making use of archival climate data and primary data from key informants and field observations, it emerged that there is a statistically significant increase in the frequency of flooding and consequent human and economic losses from such in the coastal cities of the province. Flooding in urban areas of the Western Cape is a factor of human and natural factors ranging from extreme rainfall, usually caused by persistent cut off-lows, midlatitude cyclones, cold fronts and intense storms. Such floods become compounded by poor drainage caused by vegetative overgrowth on waterways and land pollution that can be traced to poor drainage maintenance. Clogging of waterways and drainage systems enhances the risk of flooding. Increased urbanisation, overpopulation in some areas and non-adherence to environmental laws results in both the affluent and poor settling on vulnerable ecosystems. These include coastal areas, estuaries, and waterways, and this worsens the risk of flooding. The study recommends a comprehensive approach to deal with factors that increase the risk of flooding as informed by the provisions of both the Sustainable Development Goals framework and the Sendai Framework for Disaster Risk Reduction 2015-2030 in a bid to de-risking human settlement in South Africa.

The dynamics of indiscriminate/ illegal dumping of waste in Fisantekraal, Cape Town, South Africa.

Indiscriminate dumping may be considered a 'wicked problem', as it is regarded as a complex, intractable, open-ended problem and it includes rights-based and justice issues. An understanding of the dynamics of indiscriminate dumping may assist with improving the management of indiscriminate dumping. The results show that indiscriminate dumping in Fisantekraal is a serious threat. From the first round of data collection to the last, no dumpsite disappeared despite the efforts of the community to clean up each month. Rather, the formation of new dumpsites and the extension of a few existing ones were evident. The morphology composition of the waste suggests that the main dumpers are the households and spaza shop owners. Conversations and collaboration between the authorities and community are encouraged in order to explore solutions to indiscriminate dumping.

Provincial Veterinary Services respond to drought in South Africa.

In 2018, Cape Town, South Africa, nearly ran out of water. That this has not yet happened is in large part due to the water-saving efforts of its citizens. It is highly likely that this situation will be repeated in Cape Town and that similar situations will be experienced by major cities in other parts of the world. Efforts to save water should thus continue and the lessons learned in Cape Town should be shared. The functioning of Veterinary Services during a drought is affected in the same way as any business, in terms of running an office, but veterinary professionals face an increased risk of exposure to pathogens, compared to that of many occupations, and of veterinary officials becoming disease vectors. One component of Veterinary Services is veterinary laboratory services. Laboratory procedures rely heavily on water and, without advance planning, a laboratory's function can be severely limited by a restricted water supply. In many cases, innovative water-saving techniques can be used to reduce water use substantially without compromising the quality of the services offered. Here, the authors share their experiences and some lessons learned while working in Veterinary Services in the Western Cape province of South Africa.

En 2018, la ville du Cap en Afrique du Sud a failli manquer d'eau. Si la pénurie totale a pu être évitée, ce fut en grande partie grâce aux efforts déployés par les habitants pour économiser l'eau. Or, il est très probable que cette situation se reproduise au Cap et que des situations analogues surviennent dans nombre de grandes métropoles d'autres régions du monde. C'est pourquoi il convient de poursuivre les efforts d'économie d'eau et de partager avec d'autres les enseignements tirés dans la ville du Cap. L'impact de la sécheresse sur le fonctionnement des Services vétérinaires est similaire à celui de toute organisation en termes de gestion administrative ; en revanche, par rapport à d'autres professionnels, les vétérinaires de terrain sont davantage exposés à des agents pathogènes et au risque de devenir eux-mêmes vecteurs de maladies. Les laboratoires vétérinaires sont l'une des composantes des Services vétérinaires. Les procédures de laboratoire sont amplement tributaires de l'eau ; or, en l'absence d'une planification préalable, les activités d'un laboratoire pourraient être gravement mises à mal par des restrictions de l'approvisionnement en eau. Dans bien des cas, il est possible d'utiliser des techniques innovantes pour économiser l'eau afin d'en diminuer la consommation sans pour autant compromettre la qualité des services rendus. Les auteurs font part de leur expérience et de certains enseignements tirés lorsqu'ils travaillaient dans les Services vétérinaires de la province du Cap-Occidental en Afrique du Sud.

En 2018 faltó poco para que Ciudad del Cabo (Sudáfrica) se quedara sin agua. Si las cosas aún no han llegado a este extremo es, en gran parte, gracias a los esfuerzos de los habitantes por economizar agua. Es muy probable que en el futuro Ciudad del Cabo vuelva a sufrir esta situación y que grandes metrópolis de otras partes del mundo conozcan dificultades parecidas. Por ello hay que perseverar en los esfuerzos de ahorro de agua y se deben compartir las enseñanzas extraídas en Ciudad del Cabo. Durante una sequía, el funcionamiento de los Servicios Veterinarios se ve afectado del mismo modo que cualquier otra actividad, por lo que respecta al trabajo de oficina, pero además los profesionales del ramo, en comparación con los de otros muchos sectores, corren mayor peligro de exposición a patógenos, lo que a su vez entraña el riesgo de que los propios veterinarios ejerzan de vectores de la enfermedad. Uno de los puntales de los Servicios Veterinarios son los laboratorios veterinarios, cuyo quehacer depende en gran medida del uso de agua. Por ello, cuando no se ha planificado con antelación la eventualidad de una penuria de agua, esta puede imponer graves cortapisas a las funciones de laboratorio. En muchos casos es posible emplear innovadoras técnicas de ahorro de agua para reducir sustancialmente las cantidades utilizadas sin menoscabo de la calidad de los servicios dispensados. Los autores comparten su experiencia y algunas de las lecciones que extrajeron de su trabajo en los Servicios Veterinarios de la provincia sudafricana del Cabo Occidental.

Microplastics in Mussels Along the Coast of Cape Town, South Africa.

Microplastic (MP) contamination in marine organisms is a growing field of research internationally. However not much is known about MP presence in invertebrates in southern Africa. The aim of this study was to determine whether MPs occurs in mussels prevalent in Cape Town, South Africa. Mussels (Mytilus galloprovincialis, Choromytilus meridionalis and Aulacomya ater) were sampled at 27 sites in October 2018 and MPs were recorded in 98% of mussels analysed. Most MPs were filaments, dark in colour and the size ranged between 50 and 1000 µm. There were no significant differences in MPs between the mussel species, with an average of 2.33 (standard error ± 0.2) MP particles/g and 4.27 (standard error ± 0.5) particles/individual being recorded for all sites combined. This is the first record of MPs in mussels in the region and provides a baseline for further investigations and monitoring of MPs.

Occurrence of Campylobacter species from broiler chickens and chicken meat in Malaysia.

Campylobacter is reported as a major cause of foodborne illness worldwide. Consumption of contaminated chicken meat is considered a significant risk factor of Campylobacter infection in humans. This study investigated the occurrence of non-Campylobacter jejuni-Campylobacter coli, in broiler chickens (n = 210) and chicken meat (n = 109). The samples were collected from seven broiler chicken farms (n = 210 cloacal swabs), 11 markets (n = 84 chicken meat), and 5 supermarkets (n = 25 chicken meat) located in different districts of Selangor State. Campylobacter were isolated from cloacal swabs using the Cape Town Protocol and from meat samples using the method of Duffy et al. (2007) with some modifications for Campylobacter isolations which were reported effective in the isolation of non-C. jejuni-C. coli Campylobacter species. The isolates were identified by Gram staining for cellular morphology, wet mount for motility and biochemical tests. Confirmation of presumed Campylobacter isolates was carried out using multiplex PCR (mPCR). One hundred seven (107/210) or 50.9% and twenty-nine (29/109) or 26.6% of chickens and chicken meat samples respectively were positive for Campylobacter species. Among the Campylobacter isolates from chickens, C. jejuni was the most predominantly isolated species (69.5%), followed by C. coli (16.2%). Campylobacter fetus and C. upsaliensis were the non-C. jejuni-C. coli Campylobacter species isolated in this study, at 9.3% and 2.5% respectively. Overall, the findings indicated broiler chickens were colonized not only by the common Campylobacter species but also by other Campylobacter species. We found the Cape Town Protocol useful to detect the occurrence of non-C. jejuni-C. coli isolates in chickens.

Healthcare workers' beliefs, motivations and behaviours affecting adequate provision of sexual and reproductive healthcare services to adolescents in Cape Town, South Africa: a qualitative study.

BACKGROUND: Adolescents' sexual and reproductive healthcare (SRH) needs have been prioritized globally, and they have the rights to access and utilize SRH services for their needs. However, adolescents under-utilize SRH services, especially in sub-Saharan Africa. Many factors play a role in the under-utilization of SRH services by adolescents, such as the attitude and behaviour of healthcare workers. The aim of this study therefore, was to explore and gain an in-depth understanding of healthcare workers' beliefs, motivations and behaviours affecting adequate provision of these services to adolescents in South Africa. METHODS: Twenty-four healthcare workers in public SRH services in Cape Town, South Africa participated in this qualitative study through focus group discussions. To fulfill the aims of this study, nine focus group discussions were conducted among the SRH nurses. RESULTS: SRH nurses indicated that they are experiencing challenges with the concept and practice of termination of pregnancy. They explained that this practice contradicted their opposing beliefs and values. Some nurses felt that they had insufficient SRH skills, which hinder their provision of adequate SRH services to adolescents, while others described constraints within the health system such as not enough time to provide the necessary care. They also explained having limited access to schools where they can provide SRH education and pregnancy prevention services in the surrounding area. CONCLUSIONS: Nurses are faced with numerous challenges when providing SRH services to adolescents. Providing the nurses with training programmes that emphasize value clarification may help them to separate their personal beliefs and norms from the workplace practice. This may help them to focus on the needs of the adolescent in a way that is beneficial to them. At the health systems level, issues such as clinic operating hours need to be structured such that the time pressure and constraints upon the nurse is relieved.

A descriptive study of treatment provision for problem alcohol drinking in adult males in Khayelitsha, Cape Town, South Africa.

BACKGROUND: Poor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barriers to treatment seeking. This descriptive study examined the availability and nature of problem drinking treatment facilities in Khayelitsha, a largely poor township of Black, Xhosa-speaking Africans, on the outskirts of Cape Town. METHODS: Seven treatment facilities for problem drinking in adult males were identified using data from the Department of Social Development in the City of Cape Town. Staff members were identified as key informants at each of the treatment facilities, and were interviewed using a structured questionnaire. Twelve interviews were conducted. RESULTS: Findings indicated that the available alcohol treatment facilities were relatively new, that treatment modalities varied both across and within treatment facilities, and that treatment was provided largely by social workers. Treatment facilities did not accommodate overnight stay for patients, operated during weekday office hours, and commonly referred patients to the same psychiatric hospital. DISCUSSION: The study provides a baseline for assessing barriers to treatment for problem drinking in Khayelitsha by highlighting the nature of available facilities as playing a predominantly screening role with associated social work services, and a point of referral for admission to a psychiatric institution for treatment. The social and financial implications of such referral are pertinent to the discussion of treatment barriers. CONCLUSIONS: Recommendations are made to inform policy towards locally-provided integrated care to improve treatment provision and access.

Fire deaths in Cape Town, South Africa: A retrospective review of medico-legal and toxicological findings (2006 - 2018).

BACKGROUND: In South Africa, fire-related deaths are common, particularly within dense informal housing settlements. Published data on deaths from fire incidents in Cape Town is sparse. Additionally, little emphasis has been placed on the role of toxicological investigations in these deaths, despite the known risk of alcohol and drug impairment to burn injury. METHODS: A retrospective, descriptive analysis of post-mortem case reports from Salt River Mortuary was conducted to investigate all deaths in which fires were involved in the west metropole of Cape Town, between 2006 to 2018. Demographic, circumstantial, and toxicological data were analyzed using R software. RESULTS: In total 1370 fire deaths occurred over 13 years, with a mean of 106 (SD ± 18) cases per annum (≈3% of the annual caseload and a mortality rate of 5.5 per 100,000). Males (70.4%), adults (mean=30.7 years), and toddlers (1-4 years old) were notably at risk. Deaths typically occurred in the early morning (00h00 - 06h00) (45.7%), during winter (32.1%), and in lower socioeconomic areas with highly dense informal settlements (65.6%), with 29% of deaths occurring in multi-fatality incidents. Ethanol was detected (≥0.01 g/100 mL) in 55.1% of cases submitted for analysis (71.5%), with a mean of 0.18 g/100 mL, and with 93.8% of positive cases > 0.05 g/100 mL. Carboxyhaemoglobin (COHb) analysis was requested in 76.4% of cases, with 57% of cases having a %COHb of ≥ 20%. Toxicology results (for drugs other than ethanol) from the national laboratory were outstanding in 34.4% of the cases at the conclusion of the study. BAC and %COHb were significantly higher in deaths from burns and smoke inhalation (usually accidents) than deaths from combined trauma and burns (typically homicides). Fire deaths with high COHb levels were more likely to display cherry-red discoloration (OR=3.1) and soot in the airways (OR=2.7) at autopsy. CONCLUSION: This article provides an updated description of fire deaths in the west metropole of Cape Town. The importance of BAC and COHb testing in these cases was noted, and the authors call for an investigation of the role of drug impairment (specifically frequently misused drugs methamphetamine and methaqualone) as a risk factor in these deaths. Areas of high-density informal settlements, where open flames are used to heat, light, and cook, were noted as high risk.

Portion size matters: Carrion ecology lessons for medicolegal death investigations-A study in Cape Town, South Africa.

Forensic taphonomic studies are regionally specific and improve time since death estimates for medico-legal casework. Within forensic taphonomy and carrion ecology, vertebrate scavengers are under-researched with many studies conducted using multiple, unclothed carcasses. This is a forensically unrealistic experimental design choice with unknown impact. The effect of variation in carrion biomass on the decomposition ecosystem, particularly where vertebrate scavengers are concerned, requires clarification. To assess the effect of carrion biomass load on vertebrate scavenging and decomposition rate, seasonal baseline data for single, clothed ~60 kg porcine carcasses were compared to clothed multiple-carcass deployments, in a forensically relevant habitat of Cape Town, South Africa. Decomposition was tracked via weight loss and bloat progression and scavenging activity via motion-activated cameras. The single carcasses decayed more quickly, particularly during the cooler, wetter winter, strongly correlated with concentrated Cape gray mongoose (Galerella pulverulenta) scavenging activity. On average and across seasons, the single carcasses lost 68% of their mass by day 32 (567 accumulated degree days [ADD]), compared to 80 days (1477 ADD) for multi-carcass deployments. The single carcasses experienced substantially more scavenging activity, with longer visits by single and multiple mongooses, totaling 53 h on average compared to 20 h for the multi-carcass deployments. These differences in scavenging activity and decay rate demonstrate the impact of carrion biomass load on decomposition for forensic taphonomy research. These findings need corroboration. However, forensic realism requires consideration in taphonomic study design. Longitudinally examining many single carcasses may produce more forensically accurate, locally appropriate, and usable results.

Diagnostic Yield of Stereotactic Brain Biopsy in a Sub-Saharan Tertiary Center: A Comprehensive 10-Year Retrospective Analysis.

BACKGROUND: Stereotactic brain biopsy is a crucial minimally invasive surgical technique leveraged to obtain tissue specimens from deep-seated intracranial lesions, offering a safer alternative to open craniotomy for patients who cannot tolerate the latter. Despite its effectiveness, the diagnostic yield varies across different centers and has not been widely studied in Sub-Saharan Africa. METHODS: A single-center retrospective analysis was conducted on 67 consecutive stereotactic brain biopsy procedures carried out by experienced neurosurgeons between January 2012 and December 2022 at a tertiary center in Sub-Saharan Africa. Preoperative clinical status, biopsy type, postoperative complication rate, and histological diagnosis were meticulously analyzed. Factors associated with negative biopsy results were identified using IBM Statistical Package for the Social Sciences SPSS version for Mac, with Fisher exact test employed to detect differences in patient characteristics. Statistical significance was pegged at P < 0.05. RESULTS: The overall diagnostic yield rate was 67%. Major contributors to negative biopsy outcomes were superficial location of the lesion, lesion size less than 10 cc, and the use of the Cape Town Stereotactic System. Enhanced yield rates of up to 93% were realized through the application of magnetic resonance imaging-based images, Stealth Station 7, and frozen section analysis. No correlation was observed between the number of cores obtained and the yield rate. Procedure complications were negligible, and no procedure-related mortality was recorded. CONCLUSIONS: The diagnostic yield rate from our study was somewhat lower than previously reported in contemporary literature, primarily attributed to the differing definitions of diagnostic yield, the dominant use of the older framed Cape Town Stereotactic System, computed tomography-based imaging, and the absence of intraoperative frozen section. Nevertheless, biopsies conducted using the frameless system were comparable with studies from other global regions. Our findings reaffirm that stereotactic brain biopsy when complemented with magnetic resonance imaging-based imaging, frameless stereotactic systems and intraoperative frozen section is a safe, effective, and reliable method for obtaining histological diagnosis.

Severe efavirenz associated neurotoxicity: A retrospective cohort study.

Background: Efavirenz (EFV) is associated with neuropsychiatric symptoms. Severe neurotoxicity has been reported but the clinical phenotype and risk factors are poorly defined. Objectives: To characterise clinical presentations, risk factors and outcomes to help clinicians recognise severe neurotoxicity earlier. Method: The authors retrospectively identified adults with supratherapeutic EFV concentrations (> 4 mg/L) obtained during routine clinical care in Cape Town, South Africa. Clinical and laboratory data at the time of EFV quantification were extracted from medical records. Logistic regression was performed to identify associations with neuropsychiatric symptoms, and with severe neurotoxicity. Results: Eighty one patients were included; 62 with neuropsychiatric manifestations (most frequently ataxia [n = 20] and psychomotor slowing [n = 24]); and 19 with hepatotoxicity. Overall, 28 (34.6%) were male, 49 (60.5%) had concomitant isoniazid exposure, and median EFV concentration was 12.1 mg/L (interquartile range [IQR]: 6.6-20.0). Neuropsychiatric symptoms were associated with longer duration of EFV therapy, adjusted odds ratio (aOR) 1.3/180-day increment (95% confidence interval [CI]: 1.0-1.7); higher EFV concentrations, aOR 1.2/1 mg/L increase (95% CI: 1.0-1.4) and isoniazid exposure, aOR 8.2 (95% CI: 2.5-26.7). Severe neuropsychiatric symptoms occurred in 47 (75%) patients at a median of 5.9 months (IQR: 2.1-40.8) after EFV initiation. Severe symptoms odds were 1.2-fold higher (95% CI: 1.1-1.4) per 1 mg/L increase in EFV concentration. Symptoms resolved completely within 1 month in 25 (76%) patients with severe neurotoxicity who discontinued EFV. Conclusion: A concentration-effect relationship for severe neurotoxicity exists, which occurred late and resolved in most patients after EFV discontinuation. Contribution: The authors highlighted clinical heterogeneity and morbidity of EFV-associated neurotoxicity.

If You Build It Will They Come? Park Upgrades, Park Use and Park-Based Physical Activity in Urban Cape Town, South Africa-The SUN Study.

The development and upgrade of recreational public spaces are key government strategies to increase opportunities for physical activity (PA) and enhance social interaction and community cohesion. This study aimed to evaluate differences in park use and park-based PA in recently upgraded/developed parks (intervention, n = 4) against established parks (control, n = 4) and in regional parks in high- and low-income settings (n = 2). Additionally, associations between target area features, park use and PA were identified. Direct observation of park use and attributes was conducted using the System for Observing Play and Recreation in Communities (SOPARC) over four months. Despite more park users in intervention parks (2519 vs. 1432), control park visitors were 48% more likely to be engaged in PA (p < 0.001). Similarly, while high-income park users attracted more visitors (2135 vs. 1111), they were 79% less likely to be engaged in any PA compared with low-income park visitors. The likelihood of both use of and PA by gender and age differed by features. Active recreation features in intervention parks attracted more users than the same features in control parks. In this study, upgraded or newly developed parks attracted more visitors but not necessarily overall greater levels of physical activity.

Informing regional taphonomy research using retrospective forensic anthropology cases in the Western Cape, South Africa.

The post-mortem interval (PMI) is important in death investigations as it can assist in reconstructing the context of the case and the identification of the unknown individual. However, in some instances the PMI is challenging to estimate due to the absence of regional taphonomy standards. To conduct accurate and locally relevant forensic taphonomy research, investigators require insight into the regional hotspot recovery areas. Thus, forensic cases examined by the Forensic Anthropology Cape Town (FACT) in the Western Cape (WC) province of South Africa between 2006 and 2018 (n = 172 cases; n = 174 individuals) were retrospectively reviewed. In our study, a considerable number of individuals did not have the PMI estimations (31 %; 54/174) and the ability to estimate a PMI was significantly associated with skeletal completeness, unburnt remains, absence of clothing and the absence of entomological evidence (p < 0.05 for each). Significantly fewer cases had the PMI estimated after FACT was formalised in 2014 (p < 0.0001). One third of cases with PMI estimations were made with large open-ended ranges, making them less informative. Factors significantly associated with these broad PMI ranges were fragmented remains, absence of clothing and absence of entomological evidence (p < 0.05 for each). Most decedents (51 %; 87/174) were discovered in police precincts from high crime areas, yet a considerable number (47 %; 81/174) were also found in low crime and sparsely populated areas regularly used for recreational activities. Common sites of body discovery were vegetated areas (23 %; 40/174), followed by the roadside (15 %; 29/174), aquatic environments (11 %; 20/174) and farms (11 %; 19/174). Decedents were discovered exposed (35 %; 62/174), covered with items such as bedding or shrubs (14 %; 25/174) or buried (10 %; 17/174). Our data highlight gaps in forensic taphonomy studies and clearly informs what regional research is needed. Overall, our study demonstrates how forensic case information can inform regional forensic taphonomy studies to locate common areas and contexts for the discovery of decomposed bodies and encourages similar studies in other areas of the world.

Mistrust in government and National Health Insurance: A qualitative study of solo private practitioners in Cape Town.

BACKGROUND:  The participation of independent private general practitioners (GPs) is of fundamental importance to the successful implementation of key elements of the proposed National Health Insurance (NHI) reform, notably the contracting units for primary health care (CUPS). This study explored knowledge and perceptions of the NHI reforms of private GPs following the tabling of the NHI Bill in parliament in 2019. METHODS:  An explorative qualitative research methodology was adopted. Using a semi-structured guide, nine solo private GPs, purposefully selected to represent the range of practices in the southern peninsula of Cape Town were interviewed in depth by B.L.P. over the period from January 2021 to March 2022. RESULTS:  The GPs indicated support for the values of greater equity outlined in the NHI proposals. However, they had little engagement on or knowledge of their potential future roles in NHI. Concerns over financial viability and design were underpinned by an overall mistrust in the public sector to implement and manage NHI. CONCLUSION:  The study concurs with previous research that private GPs are broadly in support of the principles of, and are potential allies, in advancing NHI. General practitioners need a platform to share their concerns and contribute as co-designers of NHI reforms. In the interim, steps to increase collaboration between private and public sectors at local and provincial level through, for example, referral processes may help to build the trust that is necessary between the sectors.Contribution: This study foregrounds the role of trust relationships in advancing NHI.

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.