Vaginal douching and vaginal substance use among sex workers in KwaZulu-Natal, South Africa

A local cultural practice that may enhance sexually transmitted infections (STIs) and HIV transmission is vaginal douching and vaginal substance use. These activities also have potential implications for the acceptability of HIV-prevention strategies such as the use of condoms and vaginal microbicides. We aimed to establish the prevalence, determinants and reasons for these practices among sex workers in KwaZulu-Natal, South Africa. A structured questionnaire was administered to 150 sex workers, who were being screened for a vaginal microbicide-effectiveness trial in the province. The questionnaire sought information on the frequency, reasons for and nature of vaginal douching and vaginal substance use and was drawn up on the basis of findings from a pilot study. Seventy per cent (95% CI: 62.0-77.2%) of the sex workers were HIV positive and on average they had five sexual partners per day. Vaginal douching and vaginal substance use were common among the sex workers. Vaginal douching was reported by 97% (n = 146) of the respondents and 94% reported vaginal substance use for 'dry sex'. A combination of traditional remedies, patent medicines, antiseptics and household detergents was used to clean and make the vagina dry and tight. The primary reasons reported for dry sex were to increase men's sexual pleasure (53%) and to attract clients and generate more money (20%). Sixty-five per cent of the women reported the practice of douching mainly for hygienic purposes and 13% for the prevention and treatment of sexually transmitted infections. Douching and dry-sex practices may increase women's risk of HIV and STI infection, and may have implications for the acceptability and development of HIV-prevention barrier methods such as microbicides and the use of condoms. These barrier methods may enhance or reduce sexual pleasure for men and women who engage in the practice of vaginal douching and vaginal substance use for 'dry sex'

The epidemiology of HIV infection in Morocco: systematic review and data synthesis.

Morocco has made significant strides in building its HIV research capacity. Based on a wealth of empirical data, the objective of this study was to conduct a comprehensive and systematic literature review and analytical synthesis of HIV epidemiological evidence in this country. Data were retrieved using three major sources of literature and data. HIV transmission dynamics were found to be focused in high-risk populations, with female sex workers (FSWs) and clients contributing the largest share of new HIV infections. There is a pattern of emerging epidemics among some high-risk populations, and some epidemics, particularly among FSWs, appear to be established and stable. The scale of the local HIV epidemics and populations affected show highly heterogeneous geographical distribution. To optimize the national HIV response, surveillance and prevention efforts need to be expanded among high-risk populations and in geographic settings where low intensity and possibly concentrated HIV epidemics are emerging or are already endemic

Assessment for learning : a case study in the subject Business Studies

Published ArticleOne of the greatest paradigm shifts with the introduction of both outcomes-based education and the new CAPS (Curriculum and Assessment Policy Statements for the various subjects) in South African education has been from a purely examination-based exit point, to the inclusion of school-based assessments. The emphasis in the Business Studies curriculum is now on replacing assessment OF learning with assessment FOR learning. This article describes, by way of a case study, how to prepare Business Studies learners towards assessment FOR learning. From the findings of the case study it is apparent that Business Studies as a subject specifically aims to include tasks that comply with the requirements of tertiary education and the working world. This is done in order to build skills that will be more valuable to learners in their future careers than the amassing of knowledge which was emphasised in the old dispensation

My first three days as a first-year – The autoethnography of an autistic student

My enrolment at university was a significant milestone in my life. During my first three days as a student with autism spectrum disorder, I experienced both positive and negative situations at different campuses, including overcrowded lecture halls, residences, faculty houses, and interacting with other students. My literature review and theoretical interpretation are guided by historical institutionalism and Bakhtin’s concept of “outsideness”. These frameworks address how historical events shape the social, political, and economic behaviour of institutions in a system that treats new students who must adapt to the university’s rules, regulations, and traditions as outsiders. The frameworks mentioned above were used to understand what I experienced during my first three days at university, which set the tone for the rest of my undergraduate education, punctuated by ableness, whiteness, masculinity, and fluctuating forms of support

Meconium aspiration in South Africa

This retrospective study of 569 cases of meconium aspiration from 11 institutions in South Africa reveals a high incidence varying from 4 to 11/1 000 and a mortality rate of 12%. Mortality was significantly related to the degree of asphyxia at birth. Twenty-five per cent of the babies (136/569) required intensive care and 36% died. Of the mothers 18 - 25% were unbooked and most of the babies were inborn (87%). Babies born to primiparous mothers and to mothers over 35 years of age were at greater risk of death. In order to reduce mortality and the numbers admitted to the intensive care unit simple measures for the reduction in the incidence of this disease need to be emphasised in all teaching and training programmes

Risk factors for neonatal tetanus in KwaZulu-Natal

No Abstract

The Impact of HAART on the Respiratory Complications of HIV Infection: Longitudinal Trends in the MACS and WIHS Cohorts

Objective: To review the incidence of respiratory conditions and their effect on mortality in HIV-infected and uninfected individuals prior to and during the era of highly active antiretroviral therapy (HAART). Design: Two large observational cohorts of HIV-infected and HIV-uninfected men (Multicenter AIDS Cohort Study [MACS]) and women (Women's Interagency HIV Study [WIHS]), followed since 1984 and 1994, respectively. Methods: Adjusted odds or hazards ratios for incident respiratory infections or non-infectious respiratory diagnoses, respectively, in HIV-infected compared to HIV-uninfected individuals in both the pre-HAART (MACS only) and HAART eras; and adjusted Cox proportional hazard ratios for mortality in HIV-infected persons with lung disease during the HAART era. Results: Compared to HIV-uninfected participants, HIV-infected individuals had more incident respiratory infections both pre-HAART (MACS, odds ratio [adjusted-OR], 2.4; 95% confidence interval [CI], 2.2-2.7; p<0.001) and after HAART availability (MACS, adjusted-OR, 1.5; 95%CI 1.3-1.7; p<0.001; WIHS adjusted-OR, 2.2; 95%CI 1.8-2.7; p<0.001). Chronic obstructive pulmonary disease was more common in MACS HIV-infected vs. HIV-uninfected participants pre-HAART (hazard ratio [adjusted-HR] 2.9; 95%CI, 1.02-8.4; p = 0.046). After HAART availability, non-infectious lung diseases were not significantly more common in HIV-infected participants in either MACS or WIHS participants. HIV-infected participants in the HAART era with respiratory infections had an increased risk of death compared to those without infections (MACS adjusted-HR, 1.5; 95%CI, 1.3-1.7; p<0.001; WIHS adjusted-HR, 1.9; 95%CI, 1.5-2.4; p<0.001). Conclusion: HIV infection remained a significant risk for infectious respiratory diseases after the introduction of HAART, and infectious respiratory diseases were associated with an increased risk of mortality. © 2013 Gingo et al

Using Electronic Technology to Improve Clinical Care -- Results from a Before-after Cluster Trial to Evaluate Assessment and Classification of Sick Children According to Integrated Management of Childhood Illness (IMCI) Protocol in Tanzania.

Poor adherence to the Integrated Management of Childhood Illness (IMCI) protocol reduces the potential impact on under-five morbidity and mortality. Electronic technology could improve adherence; however there are few studies demonstrating the benefits of such technology in a resource-poor settings. This study estimates the impact of electronic technology on adherence to the IMCI protocols as compared to the current paper-based protocols in Tanzania. In four districts in Tanzania, 18 clinics were randomly selected for inclusion. At each site, observers documented critical parts of the clinical assessment of children aged 2 months to 5 years. The first set of observations occurred during examination of children using paper-based IMCI (pIMCI) and the next set of observations occurred during examination using the electronic IMCI (eIMCI). Children were re-examined by an IMCI expert and the diagnoses were compared. A total of 1221 children (671 paper, 550 electronic) were observed. For all ten critical IMCI items included in both systems, adherence to the protocol was greater for eIMCI than for pIMCI. The proportion assessed under pIMCI ranged from 61% to 98% compared to 92% to 100% under eIMCI (p < 0.05 for each of the ten assessment items). Use of electronic systems improved the completeness of assessment of children with acute illness in Tanzania. With the before-after nature of the design, potential for temporal confounding is the primary limitation. However, the data collection for both phases occurred over a short period (one month) and so temporal confounding was expected to be minimal. The results suggest that the use of electronic IMCI protocols can improve the completeness and consistency of clinical assessments and future studies will examine the long-term health and health systems impact of eIMCI

A compariso of mebendazole and albendazole in treating children with Trichuris trichiura infection in Durban, South Africa

Objective. To compare the efficacy of mebendazole 500 mg and aIbendazole 400 mg single-close treatments of Trichuris trichiura infection in children in the Durban area of KwaZuluatal, South Africa.Design. A single-blind randomised trial in children with a documented moderate infection of T. mchiura. Ova were counted in stool specimens before and 10 days after treatment by the formal-ether concentration method.Setting. Two shelters for abandoned and orphaned children in Durban.Participants. inety-six children aged between 2 and 12 years.Outcome measures. The number of children who showed reduced T. trichiura ova counts after the treatments, and reductions in ova counts, both expressed as percentages. Statistical analysis using the Wilcoxon 2-sample test and thechi-square test.Results. Eighty-two children completed the trial; 42 received mebendazole and 40 albendazole. Of the mebendazole group 85% showed a reduction in T. trichiura ova count, compared with 75% of children who received albendazole. Mebendazole treatment was associated with a median percentage reduction in ova count of 72.2%, which significantly exceeded the 44.1% reduction after albendazole (P  =0.024).Conclusion. The mebendazole 500 mg single-close therapy was more efficacious than the albendazole 400 mg singledose therapy in treating T. trichiura infection in these children

Community-based survey versus sentinel site sampling in determining the nutritional status of rural children: Implications for nutritional surveillance and the development of nutritional programmes

A study of the anthropometric status of under-5-year-olds was conducted in the Nqutu district of Kwazulu by means of a representative community-based sample and concurrent samples from primary health care clinics, preschools and primary schools.The first objective of this exercise was to determine the extent of acute nutritional stress in the district as an indication of the appropriateness of food relief efforts in the region. The absence of wasting and the high prevalence of stunting (37,5%) in the community-based sample suggested that the main problem is chronic socioeconomic underdevelopment, rather than a severe or immediate lack of food. The fact that fewer than 20% of households are in any way reliant on domestic production for their maize requirements explains why the recent drought has not had a greater impact on the nutritional status of this vulnerable group. This study confirms that the more recent emphasis of the National Nutrition and Social Development Programme on social development is appropriate.An equally important objective of this study was to evaluate the usefulness of clinics, preschools and schools as sites for the collection of anthropometric data and the development of nutritional programmes. This preliminary attempt to develop the methodology for district-based nutrition surveillance suggested that all these sites have limitations both in respect of data collection and community access. The implications of using these sites and the developments needed to improve their usefulness in a future nutrition surveillance system are discussed