Exploring the promise and reality of ward-based primary healthcare outreach teams conducting TB household contact tracing in three districts of South Africa.

BACKGROUND: Tuberculosis (TB) household contact tracing is a form of targeted active case-finding for which community health workers ('outreach teams') in South Africa are primarily responsible for its implementation. We conducted an exploratory qualitative study to understand the role of outreach teams in delivering TB household contact tracing. METHODS: The study took place in three districts of South Africa between May 2016 and February 2017. We conducted 78 in-depth interviews (IDI) (comprising 35 key stakeholders, 31 TB index patients and 12 HHCs) and five focus group discussions (FGD) (40 outreach team members in four FGDs and 12 community stakeholders in one FGD). RESULTS: Outreach teams contributed positively by working across health-related programmes, providing home-based care and assisting with tracing of persons lost to TB care. However, outreach teams had a limited focus on TB household contact tracing activities, likely due to the broad scope of their work and insufficient programmatic support. Outreach teams often confused TB household contact tracing activities with finding persons lost to TB care. The community also had some reservations on the role of outreach teams conducting TB household contact tracing activities. CONCLUSIONS: Creating awareness among outreach workers and clinic personnel about the importance of and activities related to TB household contact tracing would be required to strengthen the delivery of TB household contact tracing through the community-based primary health care teams. We need better monitoring and evaluation systems, stronger integration within a realistic scope of work, adequate training on TB household contact tracing and TB infection prevention control measures. Involving the community and educating them on the role of outreach teams could improve acceptance of future activities. These timely results and lessons learned should inform contact tracing approaches in the context of COVID-19

A qualitative exploration into the presence of TB stigmatization across three districts in South Africa

BACKGROUND: Tuberculosis (TB) stigma is a barrier to active case finding and delivery of care in fighting the TB epidemic. As part of a project exploring different models for delivery of TB contact tracing, we conducted a qualitative analysis to explore the presence of TB stigma within communities across South Africa. METHODS: We conducted 43 in-depth interviews with 31 people with TB and 12 household contacts as well as five focus group discussions with 40 ward-based team members and 11 community stakeholders across three South African districts. RESULTS: TB stigma is driven and facilitated by fear of disease coupled with an understanding of TB/HIV duality and manifests as anticipated and internalized stigma. Individuals are marked with TB stigma verbally through gossip and visually through symptomatic identification or when accessing care in either TB-specific areas in health clinics or though ward-based outreach teams. Individuals' unique understanding of stigma influences how they seek care. CONCLUSION: TB stigma contributes to suboptimal case finding and care at the community level in South Africa. Interventions to combat stigma, such as community and individual education campaigns on TB treatment and transmission as well as the training of health care workers on stigma and stigmatization are needed to prevent discrimination and protect patient confidentiality

The risk of metabolic syndrome as a result of lifestyle among Ellisras rural young adults

The study aimed to investigate the association between metabolic syndrome (MetS) and lifestyle risk factors among Ellisras adults. A cross-sectional study was conducted on 624 adults (306 males and 318 females). MetS was defined according to the criteria of the International Diabetes Federation. The prevalence of MetS was 23.1% (8.6% males and 36.8 % females). Females appeared to have higher mean values for waist circumference (WC), fasting blood glucose (FBG), total cholesterol (TCHOL) and low-density lipoprotein cholesterol (LDL-C), while males had high mean values for high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), systolic blood pressure (SBP) and diastolic blood pressure (DBP). No significant age and gender differences were observed for dietary intake. Significantly more females (51.9%) presented with increased WC than males (4.6%). Participants who had a high dietary energy intake were significantly less likely to present with larger WC (OR: 0.250 95% CI [0.161; 0.389]), low HDL-C (OR: 0.306 95% CI [0.220; 0.425]) and high LDL-C (OR: 0.583 95% CI [0.418; 0.812]) but more likely to present with elevated FBG (OR: 1.01 95% CI [0.735; 1.386]), high TCHOL (OR: 1.039 95% CI [0.575; 1.337]), high TG (OR: 1.186 95% CI [0.695; 2.023]) and hypertension (OR: 5.205 95% CI [3.156; 8.585]). After adjusting for age, gender, smoking, and alcohol status, high energy intake was more than two times likely to predict MetS in adults with a large WC (OR: 2.766 95% CI [0.863; 3.477] and elevated FBG (OR: 2.227 95% CI [1.051; 3.328]). Therefore, identifying groups that are at an increased risk and those that are in their early stages of MetS will help improve and prevent the increase of the MetS in the future

Simulation of the Irradiation Behaviour of the PBMR Fuel in the SAFARI-1 Reactor

2 Irradiation experiments for the pebble bed modular reactor PBMR fuel (coated fuel particles and pebble fuel) are planned at the South African First Atomic Reactor Installation (SAFARI-1). The experiments are conducted to investigate the behavior of the fuel under normal operating and accelerated/accident simulating conditions because the safe operation of the reactor relies on the integrity of the fuel for retention of radioactivity. For fuel irradiation experiments, the accurate knowledge and analysis of the neutron spectrum of the irradiation facility is required. In addition to knowledge of the neutron spectrum in the irradiation facility, power distributions and knowledge of nuclear heating values has to be acquired. The SAFARI-1 reactor boosts operating fluid temperatures of about 300 K. On the contrary, the PBMR can reach temperatures in up to about 1370 K under normal operating conditions. This calls for design of high temperature irradiation rigs for irradiation of the PBMR fuel in the SAFARI-1 reactor. The design of this instrument (rig) should be such that to create an isolated high temperature environment in the SAFARI-1 reactor, to achieve the requirements of the PBMR fuel irradiation program. The design of the irradiation rig i

The Use Of Ditaola (Divination Bones) Among Indigenous Healers In Sekhukhune District, Limpopo Province

The article serves as a research report on the role of “ditaola” (divination bones) in traditional healing. Twenty-five indigenous healers were selected through purposive sampling and were asked to respond to thirty-five questions that related to the classification, different kinds of falls and the interpretation of divination bones. In addition, the researchers observed the lives of the people through participant observation. The study found that theorigin and the naming of divination bones tend to reveal a very close relationship between human beings and the environment. Furthermore, the symbolic names given to the different “ditaola” seemed to make these diagnostic tools more significant in the context of indigenous healing. Unlike Western healing systems, indigenous healing was found to relyheavily on symbols and figurative language

Figurative and poetic language in indigenous healing: An African perspective

Praising in African culture and tradition is used to denote identity formations. Through praising, one’s membership to a clan, community, ethnic group or nation can be identified. In the search for a new Africa, praising, which links Africans with their past, is another form of folkloric expression that has a major role to play. This article highlights the significance of the connection that exists between indigenous healing and poetry. Using the case study method, one indigenous healer was identified and requested to participate in this study. Data was collected by using interviewing and participant observation methods. The investigation focused primarily on the different kinds of divination-bone fall spatial arrangements and their interpretations by the indigenous healer. Concept studies approach and hermeneutic analysis were used in understanding and interpreting the data since the authors’ interest was on the interpretation and analysis of usage of figurative and poetic language in indigenous healing. The study found that praising in indigenous healing plays a significant role. Through praising, the problems of the patient are brought to the fore. It was also found that figurative and poetic language is used to praise the divination bones before and after their fall. Praising was also found to be used, in some instances, to refer to the disease that the patient might be suffering from. The different kinds of animal totems and their interpretation are also discussed.Keywords: Praising, indigenous healing, ancestors, ditaola, divination bones

Pre-Diagnosis Health Seeking Behaviors and Experiences Post-Diagnosis, among Men Diagnosed with Tuberculosis in a District of Gauteng Metropolitan City, South Africa: In-Depth Interviews

Background: Tuberculosis remains the number one killer among infectious diseases in South Africa. The TB disease burden is said to be higher among males, 1.6 times more than females in 2018. Moreover, men are reported to have poor healthcare-seeking behaviors. Loss in social and physical functioning, including reduced sexual desires and changes in family life, have been reported following a TB diagnosis. This study explored the meaning that male TB patients attach to their TB diagnosis and impact of TB infection in their lives and those of the people living with them. Methods: This exploratory qualitative study was conducted among 25 participants recruited among male patients seeking TB care from two clinics in informal settlements of the city of Johannesburg. In-depth interviews with open-ended questions were conducted using an audio recorder for the collection of data. Data analysis was conducted on the NVivo version 12 software following an inductive thematic approach. Results: The ages of the participants ranged between 18 and 61 years. Most were unemployed, and only a few were married or in steady relationships. From the two emerging themes, pre-TB diagnosis health-seeking behaviors and post TB-diagnosis experiences, several subthemes were identified. For the former theme, the subthemes include, seeking help from community-based healers and self-medicating, waiting for some period to see if the alternative medicine or treatment worked, taking time to visit a healthcare facility, triggers to seek healthcare, and symptoms reported on presentation to the healthcare facility. The post-TB diagnosis subthemes include making sense of the TB diagnosis, context of disclosing the TB status, fear of social exclusion and experiences of stigma, support received during illness, life changes after TB infection and diagnosis, and lessons learned from the TB experience and future healthcare-seeking behavior. Conclusion: Secrecy about the TB diagnosis indicates fear of social exclusion, and this could be due to the highly stigmatized nature of TB. Waiting to see if alternative medication worked, delayed the TB diagnosis, with consequent late initiation of the anti-TB treatment. The life changes experienced post-TB diagnosis affect the quality of life of the participants and their families. The study recommends that these issues be addressed as a priority

A Framework for Risk Management in Small Medium Enterprises in Developing Countries

Failure to holistically manage risk in Small Medium Enterprises (SMEs) is one of the major causes of small businesses failure. To answer the research question as to what supports the adoption of Enterprise Risk Management (ERM) in SMEs, this research aims to analyse Risk Management (RM) in SMEs and develops a framework to facilitate the adoption of ERM. In achieving the primary objective, the research establishes for SMEs: the sources of information for RM; the importance of information governance in managing risk; the fundamentals of RM; and the pillars of RM. Previous research conducted on RM in SMEs reviewed the challenges of the successful implementation of ERM in SMEs and proposed different ways to address these challenges. The common ground reached by the research is that there is a need for the simplification of ERM in SMEs. We followed an interpretive philosophy with an inductive research approach and employed a qualitative methodological choice with a cross-sectional time horizon through data collection, employing a review of the scholarly literature, to, in the end, develop a conceptual Small Medium Enterprises Risk Management Framework (SMERMF). The limitation of the research is that the empirical part of the research has not been concluded yet. To present the results, that will be compared to the theory and conclude the research

Ethylenediamine functionalized waste polyethylene terephthalate-derived metal-organic framework for adsorption of palladium ions from aqueous solutions

The recovery of palladium metal is essential in order to meet its growing global demand and also to address water pollution crisis. Herein, MIL-101(Cr)/ED was fabricated from waste polyethylene terephthalate (PET) bottles and modified using ethylenediamine (ED) to retrieve divalent palladium (Pd(II)) metal ions from aqueous environment. The successful grafting of ED moieties onto MIL-101(Cr) was established by the appearance of broad bands at around 2800–3300 cm−1 on the Fourier transform infrared spectrum which was supported by the increase in binding energy using density functional theory. The adsorption experiments revealed that higher Pd(II) ion intake occurred using 30 mg of MIL-101(Cr)/ED in acidic media of pH = 3.0. The data fit better on the Langmuir isotherm with the correlation coefficient (R2) 0.9089. At 25 °C, the MIL-101(Cr)/ED achieved a substantial enhancement in the intake capacities of 454.2 mg.g−1. Kinetics data demonstrated to comply with pseudo-second order, achieving a rapid rate of Pd(II) adsorption by the MIL-101(Cr)/ED in less than 3 min given by the rate constant k2 = 0.02065 g.mg−1.min−1. The MIL-101(Cr)/ED has high affinity for Pd(II) ions as more than 80% removal was achieved even in presence of other ions. These observations revealed the potential utilization of MIL-101(Cr)/ED as an adsorbent to efficiently extract Pd(II) ions from wastewater