Health promotion: From malaria control to elimination

Here we reflect on the achievement of some of the diverse activities that have brought malaria under control, highlight key challenges and propose specific health promotion interventions required to move South Africa’s malaria programme from control to elimination

Endemic goitre in a rural community of KwaZulu-Natal

CITATION: Benade, J. G. et al. 1997. Endemic goitre in a rural community of KwaZulu-Natal. South African Medical Journal, 87:310-313.The original publication is available at http://www.samj.org.zaObjective. To quantify the prevalence of goitre and iodine deficiency. Setting. Ndunakazi, a rural community of approximately 8 000 people in KwaZulu-Natal. Design. A cross-sectional community-based survey and a school-based survey. Participants. The 127 mothers and 114 children aged 6 -11 years, selected during the cross-sectional survey, and 304 children aged 6 -14 years, from the school-based survey. Methods. Urinary iodine levels and thyroid size were determined and categorised according to guidelines proposed jointly by the WHO, UNICEF and the ICCIDD. Z-score anthropometric indicators were calculated, and mid-year exam marks of goitrous and non-goitrous pupils for Zulu and mathematics were compared. Results. In school-aged children, both surveys demonstrated a goitre prevalence in the 20 - 29.9% range and a median urinary iodine level in the 2 - 4.9 ug/dl range, indicating iodine deficiency of moderate severity. Goitrous subjects scored consistently worse in their Zulu exam papers than those without goitre. Stunting was not more prevalent than in the rest of KwaZulu-Natal. Iodised salt was not available in any of the three community shops. Conclusion. This level of iodine deficiency in children can adversely affect their neuropsycho-intellectual development. Factors contributing to deficient iodine intake in Ndunakazi are present in many rural areas, and South Africa cannot afford to be overly confident about the apparent absence of iodine deficiency as a public health problem.Publisher’s versio

An HLA-I signature favouring KIR-educated Natural Killer cells mediates immune control of HIV in children and contrasts with the HLA-B-restricted CD8+T-cell-mediated immune control in adults

Natural Killer (NK) cells contribute to HIV control in adults, but HLA-B-mediated T-cell activity has a more substantial impact on disease outcome. However, the HLA-B molecules influencing immune control in adults have less impact on paediatric infection. To investigate the contribution NK cells make to immune control, we studied >300 children living with HIV followed over two decades in South Africa. In children, HLA-B alleles associated with adult protection or disease-susceptibility did not have significant effects, whereas Bw4 (p = 0.003) and low HLA-A expression (p = 0.002) alleles were strongly associated with immunological and viral control. In a comparator adult cohort, Bw4 and HLA-A expression contributions to HIV disease outcome were dwarfed by those of protective and disease-susceptible HLA-B molecules. We next investigated the immunophenotype and effector functions of NK cells in a subset of these children using flow cytometry. Slow progression and better plasma viraemic control were also associated with high frequencies of less terminally differentiated NKG2A+NKp46+CD56dim NK cells strongly responsive to cytokine stimulation and linked with the immunogenetic signature identified. Future studies are indicated to determine whether this signature associated with immune control in early life directly facilitates functional cure in children

Extrovert Followership and its Impact on Agreeable Leadership

This study recons the need for research on effective role of followership in mentoring a leader to set pattern or direction for leader. A reinvented concept of leader being a team man needs active participation from followers in changing business dynamics. The sample consisting of middle level management having leader (heads/ supervisors from education sector) above it has been taken and results are achieved using inferential statistics, so to verify the need of followers for result oriented leadership. The results depict that certain personality traits backed by “Big Five Model” are found to be important for followers to have an impact on leader’s decision making. As this study analyses the mutual characteristic of leader follower relation statistically while putting follower on the fore front, the originality of study is ensured. As for limitation, this study may show different results as per variant geographical and economical regions in which followers’ expectations may vary accordingly

A Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008

Three national HIV household surveys were conducted in South Africa, in 2002, 2005 and 2008. A novelty of the 2008 survey was the addition of serological testing to ascertain antiretroviral treatment (ART) use.We used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. The estimated "excess" HIV prevalence due to ART in 2008 was highest among women 25 years and older and among men 30 years and older. In the period 2002-2005, the HIV incidence rate among men and women aged 15-49 years was estimated to be 2.0 new infections each year per 100 susceptible individuals (/100pyar) (uncertainty range: 1.2-3.0/100pyar). The highest incidence rate was among 15-24 year-old women, at 5.5/100pyar (4.5-6.5). In the period 2005-2008, incidence among men and women aged 15-49 was estimated to be 1.3/100 (0.6-2.5/100pyar), although the change from 2002-2005 was not statistically significant. However, the incidence rate among young women aged 15-24 declined by 60% in the same period, to 2.2/100pyar, and this change was statistically significant. There is evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth.Our analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. We also show the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence

The influence of different helminth infection phenotypes on immune responses against HIV in co-infected adults in South Africa

<p>Abstract</p> <p>Background</p> <p>The convergent distribution of the Human Immunodeficiency Virus (HIV) and helminth infections has led to the suggestion that infection with helminths exacerbates the HIV epidemic in developing countries. In South Africa, it is estimated that 57% of the population lives in poverty and carries the highest burden of both HIV and helmith infections, however, the disease interactions are under-researched.</p> <p>Methods</p> <p>We employed both coproscopy and <it>Ascaris lumbricoides</it>-specific serum IgE to increase diagnostic sensitivity and to distinguish between different helminth infection phenotypes and their effects on immune responses in HIV co-infected individuals. Coproscopy was done by formol ether and Kato Katz methods. HIV positive and negative adults were stratified according to the presence or absence of <it>A. lumbricoides </it>and/or <it>Trichuris trichuria </it>eggs with or without elevated <it>Ascaris </it>IgE. Lymphocyte subsets were phenotyped by flow cytometry. Viral loads, serum total IgE and eosinophils were also analysed. Lymphocyte activation markers (CCR5, HLA-DR, CD25, CD38 and CD71) were determined. Non parametric statistics were used to describe differences in the variables between the subgroups.</p> <p>Results</p> <p>Helminth prevalence ranged between 40%-60%. Four distinct subgroups of were identified, and this included egg positive/high <it>Ascaris</it>-specific IgE (egg⁺IgE^hi), egg positive/low IgE (egg⁺IgE^lo), egg negative/high IgE (egg^-IgE^hi) and egg negative/low IgE (egg^-IgE^lo) individuals. The egg⁺IgE^hisubgroup displayed lymphocytopenia, eosinophilia, (low CD4⁺counts in HIV^-group), high viral load (in HIV⁺group), and an activated lymphocyte profile. High <it>Ascaris </it>IgE subgroups (egg⁺IgE^hiand egg^-IgE^hi) had eosinophilia, highest viral loads, and lower CD4⁺counts in the HIV^-group). Egg excretion and low IgE (egg⁺IgE^lo) status demonstrated a modified Th₂immune profile with a relatively competent response to HIV.</p> <p>Conclusions</p> <p>People with both helminth egg excretion and high <it>Ascaris</it>-IgE levels had dysregulated immune cells, high viral loads with more immune activation. A modified Th₂helminth response in individuals with egg positive stools and low <it>Ascaris </it>IgE showed a better HIV related immune profile. Future research on helminth-HIV co-infection should include parasite-specific IgE measurements in addition to coproscopy to delineate the different response phenotypes. Helminth infection affects the immune response to HIV in some individuals with high IgE and egg excretion in stool.</p