Preventing perinatal HIV transmission in developing countries - do we know enough?

No Abstract

A comparative assessment of commonly employed staining procedures for the diagnosis of ' cryptosporidiosis

Following an increase in the number of reports of Cryptosporidium infections and the problems encountered in detecting these organisms in faecal smears, a comparative assessment of a modification of the Sheather's flotation technique and other commonly employed staining procedures proved the modified Sheather's technique to be most useful in identifying Cryptosporidium oocysts in diarrhoeal stools. This technique not only detected the parasite in the highest number of stools but also proved to be cost-effective and the least timeconsuming. Other staining techniques assessed were the modified Ziehl-Neelsen, safranin-methylene blue and auramine- phenol fluorescence. Both the modified Ziehl-Neelsen and the auramine-phenol fluorescence procedures produced nonspecific staining, while the safranin-methylene blue method was found to be the least sensitive technique

Cryptosporidium infections in children in Durban Seasonal variation, age distribution and disease status

One hundred and eleven of 1229 children (9%) aged < 10 years admitted to King Edward VIII Hospital, Durban, with gastro-enteritis over a period of 1 year were found to harbour Cryptosporidium. Of these, 96 (89,7%) were < 2 years of age. Cryptosporidium was the only potential pathogen identified in 80 of these patients (6,50/0). The prevalence in paediatric patients without gastro-enteritis was 2,4% (3/124). During the study period Cryptosporidium infections were significantly more prevalent during the high rainfall season (P = 0,03)

The association of antiphospholipid antibodies with severe early-onset pre-eclampsia

Objective. To confirm the association of antiphospholipid antibodies with early onset of severe pre-eclampsia before 30 weeks' gestation.Study design. Thirty-four patients with diastolic blood pressure levels ≥ 110 mmHg and at least 2+ proteinuria before the 30th week of pregnancy were randomly chosen for inclusion in the study. Blood samples were taken for assessment of anticardiolipin antibodies (ACAs), lupus anticoagulant, syphilitic serology and antinuclear antibodies. Fifteen normal antenatal patients matched for age, parity and gestational age acted as control subjects.Results. Four of the 34 women (11,7%) in the study group had elevated levels of both ACAs and lupus anticoagulant, compared with none in the control group. This was not found to be statistically different.Conclusion. Given the low incidence of positive ACAs in early-onset severe pre-eclampsia it is unlikely that they are implicated in its pathogenesis. It is possible that they represent a small subset of patients with alternative or combined pathology

Mapping awareness of breast and cervical cancer risk factors, symptoms and lay beliefs in Uganda and South Africa

Funder: Cancer Association of South AfricaFunder: University of Cape Town; funder-id: http://dx.doi.org/10.13039/501100007112Funder: South African Medical Research Council; funder-id: http://dx.doi.org/10.13039/501100001322Funder: National Department of Health; funder-id: http://dx.doi.org/10.13039/100009041Funder: UK Medical Research CouncilFunder: Newton Fund; funder-id: http://dx.doi.org/10.13039/100010897Background: Breast and cervical cancer are leading causes of cancer burden in Sub-Saharan Africa (SSA). We measured breast and cervical cancer symptom and risk factor awareness and lay beliefs in Uganda and South Africa (SA). Methods: Between August and December 2018 we conducted a cross-sectional survey of women ≥18 years in one urban and one rural site per country. Households were selected using systematic random sampling, then one woman per household randomly selected to participate. Data were collected by interviewers using electronic tablets customised with the locally validated African Women Awareness of Cancer (AWACAN) tool. This has unprompted questions (testing recall) followed by prompted questions (testing recognition) on risk factor, symptom awareness and lay beliefs for breast and cervical cancer. Mann Whitney and Kruskal Wallis tests were used to compare the association between socio-demographic variables and outcomes. Poisson regression with robust variance was conducted to identify independent socio-demographic predictors. Results: Of the 1758 women interviewed, 90.8% had heard of breast and 89.4% of cervical cancer. 8.7% recalled at least one breast risk factor and 38.1% recalled at least one cervical cancer risk factor. 78.0% and 57.7% recalled at least one breast/cervical cancer symptom respectively. Recognition of risk factors and symptoms was higher than recall. Many women were unaware that HPV, HIV, and not being screened were cervical cancer risk factors (23.7%, 46.8%, 26.5% respectively). In SA, urban compared to rural women had significantly higher symptom and risk factor awareness for both cancers. In Uganda married women/living with a partner had higher awareness of breast cancer risk factors and cervical cancer symptoms compared to women not living with a partner. Women mentioned several lay beliefs (e.g. putting money in their bra as a breast cancer risk factor). Conclusion: We identified gaps in breast and cervical cancer symptom and risk factor awareness. Our results provide direction for locally targeted cancer awareness intervention programs and serve as a baseline measure against which to evaluate interventions in SSA

Validation of proteins associated with pathological damage in human tuberculosis granulomas: study protocol [version 1; peer review: 2 approved]

The presence of the Tuberculosis (TB) disease-causing pathogen, Mycobacterium Tuberculosis (Mtb), induces the development of a pathological feature termed granuloma, which the host uses to contain the bacteria. However, the granuloma may dissociate resulting in detrimental caseation of the lung. The disease contributes to a growing global burden of lung function challenges, warranting for more understanding of the TB-induced immunopathology. The current study aims to explore in detail host factors that drive pathological features of TB contributing to extensive lung tissue destruction. Lung tissue sections obtained from patients undergoing surgical resection will be processed and analyzed using histopathological assays including Immunohistochemistry, Immunofluorescence, Hematoxylin and Eosin staining and Laser Capture Microdissection. The findings will provide key host factors that associate with exacerbated lung immunopathology during TB

Coming of age? Women's sexual and reproductive health after twenty-one years of democracy in South Africa

This paper is a sequel to a 2004 article thet reviewed South Africa's introduction of new sexual and reproductive health (SRH) and rights, laws, policies and programmes, a decade into democracy. Similarly to the previous article this paper focuses on key areas of women's SRH: contraception and fertility abortion maternal health HIV cervical and breast cancer and sexual violence. In the last decade South Africa has retained and expanded its sexual and reproductive health and rights (SRHR) policies in the areas of abortion contraception youth and HIV treatment (with the largest antiretroviral treatment programme in the world). These are positive examples within the SRHR policy arena. These improvements include fewer unsafe abortions AIDS deaths and vertical HIV transmission as well as the public provision of a human papillomavirus vaccine to prevent cervical cancer. However persistent socio-economic inequities and gender inequality continue to profoundly affect South African women's SRHR. The state shows mixed success over the past two decades in advancing measurable SRH social justice outcomes and in confronting and ameliorating social norms that undermine SRHR

Hard choices: Ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africa

Access to COVID-19 vaccines has raised concerns globally. Despite calls for solidarity and social justice during the pandemic, vaccine nationalism, stockpiling of limited vaccine supplies by high-income countries and profit-driven strategies of global pharmaceutical manufacturers have brought into sharp focus global health inequities and the plight of low- and middle-income countries (LMICs) as they wait in line for restricted tranches of vaccines. Even in high-income countries that received vaccine supplies first, vaccine roll-out globally has been fraught with logistic and ethical challenges. South Africa (SA) is no exception. Flawed global institutional strategies for vaccine distribution and delivery have undermined public procurement platforms, leaving LMICs facing disproportionate shortages necessitating strict criteria for vaccine prioritisation. In anticipation of our first consignment of vaccines, deliberations around phase 1 roll-out were intense and contentious. Although the first phase focuses on healthcare personnel (HCP), the devil is in the detail. Navigating the granularity of prioritising different categories of risk in healthcare sectors in SA is complicated by definitions of risk in personal and occupational contexts. The inequitable public-private divide that characterises the SA health system adds another layer of complexity. Unlike other therapeutic or preventive interventions that are procured independently by the private health sector, COVID-19 vaccine procurement is currently limited to the SA government only, leaving HCP in the private sector dependent on central government allocation. Fair distribution among tertiary, secondary and primary levels of care is another consideration. Taking all these complexities into account, procedural and substantive ethical principles supporting a prioritisation approach are outlined. Within the constraints of suboptimal global health governance, LMICs must optimise progressive distribution of scarce vaccines to HCP at highest risk