Direct Questioning of Genital Symptoms Increasing Opportunities for Identifying and Treating Sexually Transmitted Infections in Primary Health-care settings

We investigated the validity of self-reporting of genital symptoms amongst rural women attending primary health care clinics in rural KwaZulu-Natal. Random samples of 226 women were interviewed to measure self-reporting (unprompted), prompted and pelvic examination findings of genital symptoms. Against the presence of any STI self- reporting (unprompted) of symptoms had a sensitivity of 46.1%, specificity of 64.7%, positive predictive value (PPV) of 80.0% and negative predictive value (NPV) of 28.0% compared to prompted symptoms which had a sensitivity of 78.5%, specificity of 52.9%, PPV of 80.4% and NPV of 50.0%. The agreement between self- reporting (unprompted) and prompted symptoms was 0.54 (Kappa statistic). Our results suggest that in rural areas, by prompting women with a simple set of questions, the identification and treatment of STIs in this population would be enhanced, leading to better reproductive health outcomes including reduction of risk of infection with HIV. African Journal of Reproductive Health Vol. 10 (2) 2006: pp. 105-11

High AIDS-related mortality among young women in rural KwaZulu-Natal

Objective. To establish mortality rates and cause of death in a rural community in KwaZulu-Natal. This study was conducted as part of a demographic and health survey to assess the impact of HIV infection in this community. Methods. A cross-sectional survey was conducted between February and July 2004. The survey made use of structured questionnaires and verbal autopsies, which yielded detailed information at household level, including the demographic profile of residents, mortality rates and cause of mortality between February 2003 and February 2004.Results. The overall mortality rate in this community was 2.9 deaths per 100 person-years (95% confidence interval (CI): 2.5 - 3.3 per 100 person-years). The highest mortality rate among women occurred in the 30 - 34-year age group, while among men it occurred in the 35 - 39 and > 60-year age groups. Of the 185 verbal autopsies reported, 77 deaths (42%) were attributable to AIDS. The survey revealed that women aged 20 - 24 and men aged 35 - 39 years were bearing a disproportionately large burden of AIDS-related mortality in this community.Conclusion. AIDS-related mortality was found to be disproportionately high in young women in this small rural community, and the majority of deaths resulted from pulmonary tuberculosis. The need to strengthen prevention and treatment efforts in this and similar settings is highlighted

Weight and health status of black female students

Objective. To examine black female students for the occurrence of risk factors associated with chronic diseas~s of lifestyle, namely obesity, hypertension, nicotine usage, dyslipidaemia and compromised mental health (depression).Design. A cross-sectional analytical study design was used. All participants were examined within a period of 3 months during 1994. Weight, height, and hip and waist measurements were taken. Body mass index (BMI), waist-hip ratio (WHR) and waist circumference (WC) were calculated for each subject. Two systolic and diastolic blood pressure readings were taken for each participant. Questionnaires were used to determine specific risk factors related to lifestyle. The Beck Depression Inventory (BDI) was used to measure psychological well-being. Fasting blood samples were collected and analysed for serum lipids and iron status.Setting. The University of the North in the Northern Province of South Africa.Subjects. A complete data set of sociodemographic information, anthropometric measurements and blood pressure readings, as well as a psychological health test and a medical questionnaire, were obtained from 231 of the 431 first-year female students who attended the university orientation programme. Only students with a complete data set were included in the sample.Results. Eighteen per cent of students were overweight (BMI 25 - 29.9), 6.5% were obese (BMI ≥ 30), and 26.8% were underweight. Mean blood pressure, BMI, WHR and WC increased significantly with age and were highest among the  ≥ 24-year-olds. Only 1.6% of students had elevated blood pressure, 1.0% smoked and 4.4% took snuff. BMI, WC and WHR were positively correlated with blood pressure and age. Few students had dyslipidaemia (3.8% cholesterol> 5.2 mmol/l). However 14.5% were anaemic (Hb < 11.5 g/dl) and 24.6% had microcytosis « 80 fl). Nearly one-fifth of students (17.7%) were classified as being moderately to severely depressed. Conclusions. Black female students younger than 24 years exhibited few risk factors associated with chronic diseases of lifestyle. However in older women (;<,24 years) there were significant increases in BMI, WHR, WC and blood pressure. A large number of students of all ages exhibited moderate to severe depression and anaemia was prevalent

Anaerobic ammonium oxidation in the old trickling filters at Daspoort Wastewater Treatment Works

The century-old trickling filters at the Daspoort Wastewater Treatment Works in Pretoria (Gauteng, South Africa) are known for their remarkable removal of nitrogen from municipal wastewater. Our study was conducted to identify the microbiological processes responsible for this phenomenon and to establish whether anammox bacteria may be involved. An aerobic and anaerobic bench top reactor, both inoculated with biofilm-covered stones from one of the filters, were spiked with ammonia-nitrogen  (NH4+-N) and nitrite-nitrogen (NO2.-N). These reactors were subsequently monitored by conducting stoichiometric analyses of chemical oxygen demand (COD), NH4+-N, NO2.-N, and nitrate-nitrogen (NO3.-N). In the aerobic reactor, the COD concentration decreased over the 56 h batch reaction period and nitrification was revealed by a decrease in NH4+-N and NO2.-N concentrations. However, the NO3.-N concentration showed no  notable decrease. In contrast, in the anaerobic reactor the concentrations of COD, NH4+-N, NO2¡¥-N, NO3¡¥-N, as well as total nitrogen decreased during the batch reaction period. The decrease of both the NH4+-N and NO2.-N concentrations, the latter to zero under anaerobic conditions,   suggested that, in addition to heterotrophic denitrification, anaerobic ammonium oxidation (anammox) may also occur in the trickling filter biofilm. This was highlighted by the observation that ammonium removal in the anaerobic reactor stopped as soon as the nitrite concentration  became zero. The ratio of nitrite:ammonium removal was 1.33 on  average, which conforms to anammox behaviour. Gene sequence analysis was used to test for the possible presence of anammox bacteria in the  trickling filter biofilm. Genomic DNA was extracted from trickling filter  humus sludge and the polymerase chain reaction (PCR) was used to  amplify taxonomically informative 16S rRNA gene sequences, using  primers specific for selected anammox species. Subsequent sequence analysis, including using the online Basic Local Alignment Search Tool (BLAST), and constructing a phylogenic tree using a heuristic search  strategy for Maximum Parsimony analysis, confirmed the presence of an anammox bacterium closely related to Candidatus ¡®Brocadia  anammoxidans¡¯ and Candidatus ¡®Brocadia fulgida¡¯ on the biofilm-covered stones of the Daspoort trickling filters.Keywords: Daspoort, trickling filter, anammox, nitrification, denitrification, stoichiometric analyses, polymerase chain reactio

Between suffering and coping: burnout in female medical doctors in South Africa

Burnout is described as emotional and physical exhaustion, reduced accomplishment, together with an outlook of inadequacy and cynicism related to job stress. It has a harmful impact globally, especially in developing countries, such as South Africa. This study is a phenomenological collective case study focusing on burnout experience in a sample of female medical doctors working in a South African public hospital. Based on ongoing explorations of burnout themes, empirically based intervention strategies are needed to be developed and presented for the South African public health sector to prevent stress-related burnout. The findings support the trend in literature that burnout is an overwhelming experience for female medical doctors in South Africa. The study presents voices of female medical doctors, their concerns, the causes for burnout and their coping mechanisms. It provides a strong contribution to exploring and presenting women’s experiences in working in the medical field in South Africa from a positive psychology perspective. The findings indicate the struggles and the coping mechanisms of female medical doctors working in the field

Stabilizing HIV prevalence masks high HIV incidence rates amongst rural and urban women in KwaZulu-Natal, South Africa

Background: In mature generalized human immunodeficiency virus (HIV) epidemics, as survival from accessing antiretroviral treatment (ART) increases, HIV prevalence data may be suboptimal and difficult to interpret without HIV incidence rates. Objective: To determine the HIV incidence rate among rural and urban women in KwaZulu-Natal, South Africa. Methods: We conducted a prospective cohort study from March 2004 to May 2007. Volunteers were recruited from a rural family-planning clinic and an urban clinic for sexually transmitted infections. Consenting, HIV-uninfected women aged 14-30 years were enrolled. Demographic, clinical, sexual and behavioural data were collected using standardized questionnaires with HIV risk reduction counselling and HIV testing. Pelvic examinations were completed at quarterly visits. Results: The HIV prevalence at screening was 35.7% [95% confidence interval (CI) 32.7-38.8] amongst rural women and 59.3% (95% CI 56.5-62.0) amongst urban women. A total of 594/2240 (26.5%) enrolled women contributed to 602 person-years (PYs) of follow-up. The median age was 22 years [inter-quartile range 18-23 years]. HIV incidence rate was 6.5/100 PY (95% CI 4.4-9.2) amongst rural women and 6.4/100 PY (95% CI 2.6-13.2) amongst urban women. HIV incidence rate of 17.2/100 PY (95% CI 2.1-62.2) was highest amongst urban women <20 years of age and 10.2/100 PY (95% CI 4.1-20.9) amongst rural women ≥25 years of age. Conclusion: HIV incidence rates are devastatingly high in young women in rural and urban KwaZulu-Natal, despite reports of stabilized HIV prevalence observed in current surveillance data. The diffuse nature of the HIV epidemic underscores the urgent need to enhance HIV prevention and treatment modalities