Aquaponics production simulations using the decision-making tool

Aquaponics have related food and nutrition security benefit that are important for this country (South Africa). The aim of this study was to apply  aquaponics decision-making tool to provide potential aquaponics production data and information for South Africa. This study was designed as  2×3×3 factorial study giving 18 interactions. Because aquaponics are the production of fish and crops concurrently, yield production had two levels-  fish and crop, fish stocking density had three levels- low, optimum and higher and aquaponics scale of production had 3 levels- hobby, subsistence  and commercial scale. The summary of data of aquaponics variables from the literature was used as optimum level, lower and higher levels were  based on experimental design. Yield production (kg) of both fish and plants increased significantly (p<0.05) as fish stocking density was increased. In  hobby scale, plants yield was higher than fish yield in all levels of fish stocking density, the plant-fish yield (kg) was 40-33, 80-67 and 150-133,  respectively. In subsistence scale, fish-plant yield (kg) was 240-200, 300-267 and 400-333, respectively. In commercial scale, fish-plant yield (kg) was  600-533, 1 100-1 000, 1 500-1 333, respectively. Daily fish feed increased significantly with increase in fish stocking density across all scale of  aquaponics production (hobby<subsistence<commercial). In hobby scale, at low fish stocking, 0.65kg feed produced 1 kg fish, at optimum, 0.65kg  feed produced 1 kg fish and at higher fish stocking, 0.37kg feed produced 1 kg fish. In subsistence scale at low fish stocking density, 0.38kg feed  produced 1 kg fish, at optimum level, 0.63kg feed produced 1 kg fish and at higher level, 0.65kg feed produced 1 kg fish. In commercial scale, in low  fish stocking, 0.64kg feed produced 1 kg fish, at optimum, 0.63kg feed produced 1 kg fish and at higher fish stocking, 0.64kg feed produced 1 kg  fish. Plant culture have more yield output than fish culture in all aquaponics scale of production. Hobby scale produced the lowest yield than  subsistence than commercial scale of production. Hobby scale practise could not produce sufficient yield to support human subsistence. Fish feed  closely mirrored yield production. Lower fish stocking density maybe adopted in subsistence scale. Higher fish stocking density maybe adopted in  commercial scale. Fish feed could become an economic sustainability constraint in aquaponics production, particularly in a developing country like South Africa. Water availability and quality effects on yield was not determine especially in African context

Stakeholders perceptions regarding implementing maternal and newborn health care programs in Rwanda.

HEARD, 2021.Background: While maternal and newborn deaths has been decreasing since 2008 in Rwanda, there is room for improvement to meet its sustainable development goals. The maternal and newborn health care program needs to be monitored to ensure its effective implementation. This study therefore aimed to explore stakeholder’s perceptions of the Rwandan maternal and newborn health care program to identify areas for improvement. Methods: The convergent, parallel, mixed method study used quantitative and qualitative data in a single phase. The quantitative data was obtained from 79 health care workers, ranging from maternal community health care workers to program supervisors. The 10 areas of the Project Implementation Profile (PIP) instrument checklist with a five-point Likert scale were used to indicate their perceptions (strongly disagree to strongly agree). The qualitative interviews of five nurse managers used a manifest inductive content analysis, directed approach that entailed using existing theory and prior research to develop the initial coding scheme before starting data analyse. Results: There was disagreement about the level of top management support, human resources was regarded as an area of concern, with 18.7% (n = 14/79) indicating that they did not agree that this was adequately provided for; urgent solutions for unexpected problems was regarded as an areas of concern by 46.8% (n = 36/79). Top management support weakness were inadequate support training, materials, money for home visits, supervision and leaderships, and training of newly recruited maternity health care workers. For human resources, there were insufficient trained staff to take care of mothers and newborns due to the shortages of health providers. The management of unexpected problems was also an area of concerns and related to getting patients to health facilities during pregnancy emergencies and the lack of qualified birth attendants at health facilities. Conclusion: The study identified three areas for improvement: top management support, human resources and urgent solutions for unexpected problems, as they may be affecting the provision of maternal and newborn health care program services. Using the PIP enable managers to improve the country’s maternal and newborn health care program, and to provide ongoing monitoring and evaluation of with respect to the desired outcomes of reducing maternal and neonatal mortality

Using joint models to study the association between CD4 count and the risk of death in TB/HIV data

BACKGROUND: The association structure linking the longitudinal and survival sub-models is of fundamental importance in the joint modeling framework and the choice of this structure should be made based on the clinical background of the study. However, this information may not always be accessible and rationale for selecting this association structure has received relatively little attention in the literature. To this end, we aim to explore four alternative functional forms of the association structure between the CD4 count and the risk of death and provide rationale for selecting the optimal association structure for our data. We also aim to compare the results obtained from the joint model to those obtained from the time-varying Cox model. METHODS: We used data from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) AIDS Treatment programme, the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPiT) study, an open-label, three armed randomised, controlled trial between June 2005 and July 2010 (N=642). In our analysis, we combined the early and late integrated arms and compared results to the sequential arm. We utilized the Deviance Information Criterion (DIC) to select the final model with the best structure, with smaller values indicating better model adjustments to the data. RESULTS: Patient characteristics were similar across the study arms. Combined integrated therapy arms had a reduction of 55% in mortality (HR:0.45, 95% CI:0.28-0.72) compared to the sequential therapy arm. The joint model with a cumulative effects functional form was chosen as the best association structure. In particular, our joint model found that the area under the longitudinal profile of CD4 count was strongly associated with a 21% reduction in mortality (HR:0.79, 95% CI:0.72-0.86). Where as results from the time-varying Cox model showed a 19% reduction in mortality (HR:0.81, 95% CI:0.77-0.84). CONCLUSIONS: In this paper we have shown that the “current value” association structure is not always the best structure that expresses the correct relationship between the outcomes in all settings, which is why it is crucial to explore alternative clinically meaningful association structures that links the longitudinal and survival processes

Community-based maternal and newborn interventions in Africa: systematic review.

HEARD, 2021.Aim and objectives: This review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths. Background: Most neonatal deaths (99%) occur in low-and middle-income countries, with approximately half happening at home. In resource-constrained settings, community-based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub-Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015. Methods: The review includes quantitative, qualitative and mixed-method studies, with a data-based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist. Results: The results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health. Conclusion: The systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services. Relevant to the clinical practice: Conceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers

Kwazulu-Natal minibus taxi drivers’ perceptions on HIV and AIDS: Transmission, prevention, support and effects on the industry

In South Africa, the minibus taxi drivers are largely becoming another high-risk category in the HIV and AIDS epidemic. Although previous studies have shown that knowledge of HIV and AIDS is relatively high among the taxi drivers it is still not clear how this sub-population perceive the support rendered to them with regard to HIV and AIDS prevention strategies. This study aimed to focus on this atypical workplace and explore the KwaZulu-Natal, minibus taxi drivers’ perceptions on HIV and AIDS. In this study, qualitative methods were utilized to determine the minibus taxi drivers’ understanding of HIV and AIDS infection, HIV prevention strategies, existing support strategies and effects of HIV and AIDS on the taxi industry. Focus-group discussions were conducted, to collect data. The results showed that even though the taxi drivers had some understanding on HIV and AIDS there was still a dire need for interventions that were geared towards addressing HIV-related needs of the drivers in this industr

Women’s experiences on the use of Implanon as a contraceptive method in a selected primary healthcare facility in KwaZulu-Natal

Background: The South African department of health recently introduced subdermal Implanon contraceptive implant with the aim to reduce teenage pregnancy and maternal mortality. First used in all public healthcare facilities across the country since early 2014, this method of contraception has been described as highly effective. However, some women have reported unbearable side effects, forcing them to remove the contraceptive implant early before its expiry date. Negligible emphasis has been placed on staff training and development to equip the nurses with new protocol and policies on Implanon. Objectives: The objective of this study was to explore experiences of women using Implanon as method of contraception at a selected primary healthcare facility in KwaZulu-Natal province of South Africa. Methods: A qualitative, descriptive and exploratory study design was used. A purposive sampling technique was used and a sample of seven women aged between 15 and 50 years was selected for this study. Semi-structured interviews were used in the data collection process. The Tesch’s method for data coding and data analysis was utilised. Necessary ethical measures were taken to ensure that the study is trustworthy. The study was conducted at Community Health Centre, KwaZulu-Natal between June 2017 and December 2018. Results: The findings showed that some participants were still willing to continue using this method of contraception regardless of the unwanted side effects. Major side effects reported were heavy menstrual bleeding, pain and discomfort, weight loss, insomnia and decreased sexual interest, which resulted in most participants stopping the use of Implanon. Conclusion: Most of the participants’ experience unwanted side effects because of poor screening, counselling and support. There is a clear demand to develop a screening tool and facilitate training of healthcare workers when initiating the use of Implanon. Keywords: Implanon; Implanon users; experiences; perceptions; primary healthcar

High mortality in tuberculosis patients despite HIV interventions in Swaziland.

SETTING: All health facilities providing tuberculosis (TB) care in Swaziland. OBJECTIVE: To describe the impact of human immunodeficiency virus (HIV) interventions on the trend of TB treatment outcomes during 2010-2013 in Swaziland; and to describe the evolution in TB case notification, the uptake of HIV testing, antiretroviral therapy (ART) and cotrimoxazole preventive therapy (CPT), and the proportion of TB-HIV co-infected patients with adverse treatment outcomes, including mortality, loss to follow-up and treatment failure. DESIGN: A retrospective descriptive study using aggregated national TB programme data. RESULTS: Between 2010 and 2013, TB case notifications in Swaziland decreased by 40%, HIV testing increased from 86% to 96%, CPT uptake increased from 93% to 99% and ART uptake among TB patients increased from 35% to 75%. The TB-HIV co-infection rate remained around 70% and the proportion of TB-HIV cases with adverse outcomes decreased from 36% to 30%. Mortality remained high, at 14-16%, over the study period, and anti-tuberculosis treatment failure rates were stable over time (<5%). CONCLUSION: Despite high CPT and ART uptake in TB-HIV patients, mortality remained high. Further studies are required to better define high-risk patient groups, understand the reasons for death and design appropriate interventions

Condom use: a less travelled route among minibus taxi drivers and their taxi queens in KwaZulu-Natal, South Africa

Background: Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher burden of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships. Objectives: The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in KwaZulu-Natal, South Africa. Methods: Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal. Results: Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors. Conclusion: Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup

Indonesian adolescents’ experiences during pregnancy and early parenthood: a qualitative study

Background: This study explored Indonesian adolescents’ experiences of (premarital-conceived) pregnancy and early parenthood. The findings provide insight into participants’ journeys with a central thread of culture and religion running through them. Methods: Using an exploratory qualitative approach, purposive and snowball sampling techniques were used to recruit 20 participants. Overall, 36 one-to-one, in-depth interviews were conducted. Data were thematically analyzed using an inductive approach and coauthors confirmed the credibility of the analytical process. Findings: Cultural and religious ideologies about premarital sex strongly influenced government policies, social practices and unwritten social ideology, norms, values and behavior. Pre-marital pregnancy was socially unacceptable. Access to education and work was limited. Participants were nurtured by their parents with emotional, financial and nutritional support if they complied to marry and adopt socially acceptable roles. Adolescent males overwhelmingly wanted to undertake their responsibilities whilst the distress for females was overwhelming. Spirituality provided participants a way to manage their distress, seek forgiveness and develop transformational self-belief. Conclusion: Indonesian adolescents and young parents’ experiences revealed the powerful influence of cultural and religion upon policy and social structure. The study shows a unique insight into the influence of spirituality and the compliant and nurturing behavior within a family structure