Integration of the Demographic Dividend into Government Plans: A Case of the Kwazulu-Natal Province of South Africa

The Population reference Bureau policy brief, (Gribble and Bremmer, 2012):1) described the demographic dividendas “…the accelerated economic growth that may result from a decline in a country’s mortality and fertility and thesubsequent change in the age structure of the population. With fewer births each year, a country’s young dependentpopulation grows smaller in relation to the working-age population. With fewer people to support, a country has awindow of opportunity for rapid economic growth if the right social and economic policies developed and investments made”. Several South Africa based studies have explored age structure and the prospects of a demographic dividend. These studies range from those that explore timing of the dividend to those that investigate readiness to harness the dividend. Three aspects of the demographic dividend are investigated by this research. Firstly, the paper will explorethe age structure of KwaZulu-Natal population to ascertain the timing of the age-structure (youth bulge) that is a pre-requisite for the dividend. Secondly, demographic, health and education characteristics that are knows to affect the achievement of the dividend will be examined. Lastly, the extent of integration of the demographic dividend into Integrated Development Plans (IDPs) in the province will be explored

Evaluation of Xpert MTB/RIF for detection of tuberculosis from blood samples of HIV-infected adults confirms Mycobacterium tuberculosis bacteremia as an indicator of poor prognosis.

Tuberculosis (TB) remains a leading cause of death among HIV-infected adults, in part because of delayed diagnosis and therefore delayed initiation of treatment. Recently, the Gene-Xpert platform, a rapid, PCR-based diagnostic platform, has been validated for the diagnosis of TB with sputum. We have evaluated the Xpert MTB/RIF assay for the diagnosis of Mycobacterium tuberculosis bacteremia and investigated its impact on clinical outcomes. Consecutive HIV-infected adults with fever and cough presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi, were recruited and followed up for 2 months. At presentation, three sputum samples were examined by smear, culture, and Xpert MTB/RIF assay for the presence of M. tuberculosis and blood was drawn for PCR with Xpert, for mycobacterial culture (Myco/F Lytic), and for aerobic culture. One hundred four patients were recruited, and 44 (43%) were sputum culture positive for M. tuberculosis. Ten were Xpert blood positive, for a sensitivity of 21% and a specificity of 100%. The 2-week mortality rate was significantly higher among patients who were Xpert blood positive than among those who were negative (40% versus 3%; multivariate odds ratio [OR] for death if positive, 44; 95% confidence interval [CI], 3 to 662). This effect persisted on assessment of the mortality rate at 2 months (40% versus 11%; OR, 5.6; 95% CI, 1.3 to 24.6). When screening uncomplicated patients presenting with a productive cough for pulmonary TB, Xpert blood offers no diagnostic advantage over sputum testing. Despite this, Xpert blood positivity is highly predictive of early death and this test rapidly identifies a group of patients in urgent need of initiation of treatment