Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa.

This version is the Accepted Manuscript, and was published in final edited form as: J Acquir Immune Defic Syndr. 2017 April 01; 74(4): 383–389. doi:10.1097/QAI.0000000000001284OBJECTIVE: Retention in HIV care, particularly among postpartum women, is a challenge to national antiretroviral therapy programs. Retention estimates may be underestimated because of unreported transfers. We explored mobility and clinic switching among patients considered lost to follow-up (LTFU). DESIGN: Observational cohort study. METHODS: Of 788 women initiating antiretroviral therapy during pregnancy at 6 public clinics in Johannesburg, South Africa, 300 (38.1%) were LTFU (no visit ≥3 months). We manually searched for these women in the South African National Health Laboratory Services database to assess continuity of HIV care. We used geographic information system tools to map mobility to new facilities. RESULTS: Over one-third (37.6%) of women showed evidence of continued HIV care after LTFU. Of these, 67.0% continued care in the same province as the origin clinic. Compared with those who traveled outside of the province for care, these same-province "clinic shoppers" stayed out-of-care longer {median 373 days [interquartile range (IQR): 175-790] vs. 175.5 days (IQR: 74-371)} and had a lower CD4 cell count on re-entry [median 327 cells/μL (IQR: 196-576) vs. 493 cells/μL (IQR: 213-557). When considering all women with additional evidence of care as engaged in care, cohort LTFU dropped from 38.1% to 25.0%. CONCLUSION: We found evidence of continued care after LTFU and identified local and national clinic mobility among postpartum women. Laboratory records do not show all clinic visits and manual matching may have been under- or overestimated. A national health database linked to a unique identifier is necessary to improve reporting and patient care among highly mobile populations

The land question in South Africa, Zimbabwe and Kenya: a geographical perspective on resource endowment

In sharp contrast to the debates concerning land policy, land tenure and sustainable resource management in South Africa is any input concerning the geographical distribution of land productivity. This paper attempts to redress this imbalance by providing an empirical investigation of land potential in South Africa. In this way we intend to provide the crucial context for policy and academic studies of the land issue in South Africa. Furthermore, we will undertake our study in such a way that comparison can be made to Zimbabwe and Kenya where the land issue has been such a critical component of the post-colonial development process. Theoretically our work is contextualised within the debates surrounding the importance of geographical endowments, institutions and policies in the development process

Active learning for understanding land degradation : African Catchment Game and Riskmap

Land degradation is the result of the intersection of a complex set of biophysical and socio-economic factors. The capacity of an individual or community to address land degradation is likewise constrained. While it is quite possible for professionals and learners to grasp the main issues around land degradation from a theoretical perspective, internalizing the reality of what it means to be the resource degrader is more difficult. We have developed two active learning methods that aim to address this problem. The first is the African Catchment Game, a role-playing game based on Graham Chapman’s Green Revolution Game, adapted for the southern Africa context and incorporating a land degradation component. In this game participants play out the complex dynamics of rural-urban-global linkages against a background of environmental hazards. The second is based on Save the Children Fund’s RiskMap computer simulation that models risk in terms of rural livelihoods for different income groups. Ethiopia is used as the example. This paper evaluates the two active learning techniques as tools for exploring the relationships between land degradation and poverty through an evaluation of participants’ experiences

Learning About Water Management through the African Catchment Game

The African Catchment Game (ACG) is an innovative role-playing game for Geography educators that simulates a “real imaginary country”. It enables the participants to explore how rural and urban stakeholders in southern African countries may, or may not, develop scenarios of sustainable wateruse. The ACG has been developed from Graham Chapman’s the Green Revolution Game/Exaction of the 1970s and 1980s. Our modifications to Chapman’s game are under-pinned by theories of Complex Adaptive Systems and educational approaches based on constructivist, active/experiential learningmodels. This paper examines the impact of two game runs through examining the experiences of the participants and managers of the game and analyzing empirical data collected during each game run. The African Catchment Game was played twice in Finland in 2008 as part of a collaboration intended to explore the possibilities of simulations being used as tools for predicting African futures.Our analysis shows that the participants’ understanding altered and deepened as a result of playing the game. The nature of the game, as a Complex Adaptive System, and the use of a constructivist learning approach, means that the particular learning that took place cannot be extrapolated to more universalcontexts, but the value of the learning process can be more generally applied

Draft Genome Sequences of 15 Staphylococcus aureus Isolates Recovered from Raw Milk and Associated Milk Filters from Victoria, Australia

This study describes draft whole genomes of 15 Staphylococcus aureus isolates from dairy farms located in Victoria, Australia. Two novel sequence types (ST3183 and ST3184) were identified among these isolates

Extreme weather events in the Sneeuberg, Karoo, South Africa: a case study of the floods of 9 and 12 February 2011

Two destructive flood events occurred in rapid succession in the semi-arid Sneeuberg Mountains of the Karoo, South Africa in February 2011. The temporal and spatial characteristics of these two extreme events are examined in this paper through analysis of data from an unusually dense, and reliable, network of farm rain gauges. These analyses add to our understanding derived from existing rain gauge information. Comparisons are then made with patterns from a range of modeled products derived from remote sensed information: the Modern-Era Retrospective Analysis for Research and Applications (MERRA), the Tropical Rainfall Measuring Mission (TRMM) and the Global Land Data Assimilation System (GLDAS). We found that the first flood event was widespread and precipitation was related strongly to altitude. The second was highly localised, with no relationship to altitude. Both had very sharply peaked rainfall intensities. These findings are of significance to the studies of flooding and landscape change in the area as such events have become more pronounced over the past 50 yr and it is likely that this trend will accelerate. The modeled patterns are derived largely from remote sensing and we found that they are reliable for drawing out monthly and annual variations but they make noticeable underestimates. They are poor estimates, however, both for the spatial distribution of precipitation, and the short term trends as they struggle to estimate the impact of topography and other local forcing factors. This finding corroborates information derived from other analyses at broader spatial scales using more widely spread, established rain gauge stations. Ten percent of southern Africa has been classified as mountainous and these areas provide much of our water resources so our findings are significant to water managers throughout this and similar mountainous regions

Futures studies for the southern African region : ‘from Africa’ not ‘on Africa’

Futures studies is well established in the Nordic region and its history can be readily charted, but in Africa it barely exists in an institutional form and its evolution and impact is little known or understood. The first two sections of our paper briefly examine the history of futures studies, spending most attention on the African experience. We go on to show that the Higher Education landscape in the Southern African Development Community (SADC) region is very different to that in the Nordic region. Recent futures reports present forecasts and scenarios that show a differentiated Higher Education landscape in the SADC; there are few Higher Education Institutions (HEIs) and even the most optimistic forecasts show that the region as a whole will not meet the international enrollment norm of 30% by 2050. The last part of the paper examines our experience of collaboration with Finland and its well developed linkages between state and Universities. One outcome of three years of collaboration from 2007 to 2009 between two SANORD members, the Finland Futures Research Centre (now a part of the University of Turku) and Rhodes University, was a proposal to develop a multi-disciplinary, inter-institutional futures studies program intended to help Africa find its own voice in futures studies. The final part of our presentation reflects on the unsuccessful experiences that we have had to date in finding funding. We conclude by asking whether our experience can be seen as highlighting some of the challenges SANORD may be positioned to overcome if the SADC region’s HEIs are to achieve the Knowledge Village scenario and begin to match their Nordic counterparts

Poxviruses in bats … so what?

Poxviruses are important pathogens of man and numerous domestic and wild animal species. Cross species (including zoonotic) poxvirus infections can have drastic consequences for the recipient host. Bats are a diverse order of mammals known to carry lethal viral zoonoses such as Rabies, Hendra, Nipah, and SARS. Consequent targeted research is revealing bats to be infected with a rich diversity of novel viruses. Poxviruses were recently identified in bats and the settings in which they were found were dramatically different. Here, we review the natural history of poxviruses in bats and highlight the relationship of the viruses to each other and their context in the Poxviridae family. In addition to considering the zoonotic potential of these viruses, we reflect on the broader implications of these findings. Specifically, the potential to explore and exploit this newfound relationship to study coevolution and cross species transmission together with fundamental aspects of poxvirus host tropism as well as bat virology and immunology

On the fast track to land degradation? A case study of the impact of the Fast Track Land Reform Programme in Kadoma District, Zimbabwe

The Fast Track Land Reform Programme is the defining instrument for Zimbabwe’s future development prospects. In the three year period from 2000 to 2002 300,000 families were resettled on 11 million hectares thus witnessing the end of the colonial division of land which had seen 15.5 million hectares still in European hands in 1980, the start of the post-colonial period. The process which displaced the commercial farm workers and farm owners was chaotic, violent and disorderly and so has been called jambanja. Subsequent legislation and government agricultural initiatives have attempted to impose, retroactively, technocratic order to the sweeping changes that have taken place. Our study shows that the dire macro-economic situation coupled with trends of HIV/AIDS prevalence means that developing sustainable land use practices is going to be a very difficult proposition. At the local scale, our case studies show that there have been multiple outcomes with low investment, very limited government support and resource extraction leading to land degradation and unsustainable farming practices. In some instances, however, individual households have benefitted in the short term from the process but this has only occurred where climatic and soil conditions have been particularly favourable

Exploring risk related to future climates through role-playing games: the African catchment game

Risk is the result of two interacting components: hazard and vulnerability. Climatic hazards are related to extrinsic factors such as drought or severe storms. Vul- nerability is the result of intrinsic factors that often arise from the socio-political- economic context. The interplay of risk and vulnerability is difficult to predict. Although computer models have been widely used to forecast climate related risk, albeit with con- siderable uncertainty, they can never capture sufficiently the vulnerability of human sys- tems to these hazards. Role-playing games can be used more realistically to simulate pos- sible outcomes of different climate change scenarios, and allow players to reflect on their significance. The authors have developed the African Catchment Game to simulate a wa- ter scarce African country. Risk can be modelled mechanistically by changing the nature of the annual rainfall input. Vulnerability can in part be modelled by changing the start- ing parameters (such as access to land and resources) and, secondly, through the unpredictable response of players to game dynamics. Players’ reflections demonstrate that through the game they become more aware of the concept of risk and the complex response of individuals and societies that determine their vulnerability to climatic hazards. This paper reflects on the potential for developing the game further as a tool for participatory learning around climate change, based on the authors’ experience of playing the game with participants from South Africa