Sentinel seroprevalence of SARS-CoV-2 in Gauteng Province, South Africa, August - October 2020

Background. Estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) for tracking the COVID-19 epidemic are lacking for most African countries.Objectives. To determine the prevalence of antibodies against SARS-CoV-2 in a sentinel cohort of patient samples received for routine testing at tertiary laboratories in Johannesburg, South Africa.Methods. This sentinel study was conducted using remnant serum samples received at three National Health Laboratory Service laboratories in the City of Johannesburg (CoJ) district. Collection was from 1 August to 31 October 2020. We extracted accompanying laboratory results for glycated haemoglobin (HbA1c), creatinine, HIV, viral load and CD4 T-cell count. An anti-SARS-CoV-2 targeting the nucleocapsid (N) protein of the coronavirus with higher affinity for IgM and IgG antibodies was used. We reported crude as well as population-weighted and test-adjusted seroprevalence. Multivariate logistic regression analysis was used to determine whether age, sex, HIV and diabetic status were associated with increased risk for seropositivity.Results. A total of 6 477 samples were analysed, the majority (n=5 290) from the CoJ region. After excluding samples with no age or sex stated, the model population-weighted and test-adjusted seroprevalence for the CoJ (n=4 393) was 27.0% (95% confidence interval (CI) 25.4 - 28.6). Seroprevalence was highest in those aged 45 - 49 years (29.8%; 95% CI 25.5 - 35.0) and in those from the most densely populated areas of the CoJ. Risk for seropositivity was highest in those aged 18 - 49 years (adjusted odds ratio (aOR) 1.52; 95% CI 1.13 - 2.13; p=0.0005) and in samples from diabetics (aOR 1.36; 95% CI 1.13 - 1.63; p=0.001).Conclusions. Our study conducted between the first and second waves of the pandemic shows high levels of current infection among patients attending public health facilities in Gauteng Province

The Knee Osteoarthritis Grading System for Arthroplasty

Background: The aim of this study is to validate the Knee Osteoarthritis Grading System (KOGS) of progressive osteoarthritic degeneration for the tri-compartmental knee. This system defines the site and severity of osteoarthritis to determine a specific knee arthroplasty. Methods: The radiographic sequence for KOGS includes standing coronal (anteroposterior), lateral, 30° skyline patella, 15° and 45° Rosenberg and stress views in 20° of flexion. Cohen's kappa and related agreement statistical methods were used to assess the level of concordance of the 7 evaluators between A and B cohorts for each evaluator and also against the actual arthroplasty used. Sensitivity and specificity was also assessed for the KOGS in identifying true partial knee arthroplasties (PKAs) and total knee arthroplasties (TKAs) as decided from the cohort A evaluations. Results: From a cohort of 330 patients who were included in the study, 71 (22.5%) underwent a TKA procedure, 258 (78.2%) a PKA, and 1 (0.3%) was neither a TKA nor PKA. KOGS was able to identify true PKAs (sensitivity) in the range of 92.2%-98.5% across all the different evaluators. The KOGS method was able to identify a PKA or a TKA with an accuracy ranging from 92% to 98.8% across all different evaluators. The surgical results after 20 months are at least comparable with the expected average in the academic literature. Conclusion: The KOGS classification provides a reliable and accurate tool to assess suitability of an individual patient for undergoing PKA or TKA

How Treatment Partners Help: Social Analysis of an African Adherence Support Intervention

Treatment partnering is an adherence intervention developed in sub-Saharan Africa. This paper describes the additional social functions that treatment partners serve and shows how these functions contribute to health and survival for patients with HIV/AIDS. Ninety-eight minimally structured interviews were conducted with twenty pairs of adult HIV/AIDS patients (N = 20) and treatment partners (N = 20) treated at a public HIV-care setting in Tanzania. Four social functions were identified using inductive, category construction and interpretive methods of analysis: (1) encouraging disclosure; (2) combating stigma; (3) restoring hope; and (4) reducing social difference. These functions work to restore social connections and reverse the isolating effects of HIV/AIDS, strengthening access to essential community safety nets. Besides encouraging ARV adherence, treatment partners contribute to the social health of patients. Social health as well as HIV treatment success is essential to survival for persons living with HIV/AIDS in sub-Saharan Africa

The Bible and Children in Africa

The relationship between the Bible and Children in Africa is a topic of highest relevance. This book is treating it in two main perspectives which often are intertwined: | The exegetical perspective “Children in the Bible” is dealing with the concepts of childhood in biblical texts, asking for example: How are children conceived in different texts. What is their status in family, society and church? What is their relation to God? What is the metaphoric use of childhood in biblical soteriology? What is the function and meaning of calling adult persons “children” (of God, or of the Apostle)? | The contextual perspective “African children of today and the Bible” is dealing with the different life settings African children find themselves in and how the Bible is present in these life settings. Here the questions for example are: What is the status of children in family and society? How are traditional concepts of childhood changing under the conditions of poverty, HIV/AIDS and violence? How are the ideas and ideals of childhood influenced by the Bible? What is the role of the Bible in child-education? Can children’s rights be established with help of the Bible? This volume of BiAS 17 is collecting the papers presented at the 2012 BiAS meeting in Gaborone, Botswana, with some additional contributions

Estimated SARS-CoV-2 infection rate and fatality risk in Gauteng Province, South Africa : a population-based seroepidemiological survey

DATA AVAILABILITY : De-identified individual-level data and data sets generated during the current study are available for researchers who provide a methodologically sound proposal. If approved, the requestor must sign a data-use agreement. Additionally, the study protocol is available on request. All requests must be addressed to the corresponding author. Data will be available 3 months after publication of this manuscript.BACKGROUND : Limitations in laboratory testing capacity undermine the ability to quantify the overall burden of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. METHODS : We undertook a population-based serosurvey for SARS-CoV-2 infection in 26 subdistricts, Gauteng Province (population 15.9 million), South Africa, to estimate SARS-CoV-2 infection, infection fatality rate (IFR) triangulating seroprevalence, recorded COVID-19 deaths and excess-mortality data. We employed three-stage random household sampling with a selection probability proportional to the subdistrict size, stratifying the subdistrict census-sampling frame by housing type and then selecting households from selected clusters. The survey started on 4 November 2020, 8 weeks after the end of the first wave (SARS-CoV-2 nucleic acid amplification test positivity had declined to <10% for the first wave) and coincided with the peak of the second wave. The last sampling was performed on 22 January 2021, which was 9 weeks after the SARS-CoV-2 resurgence. Serum SARS-CoV-2 receptor-binding domain (RBD) immunoglobulin-G (IgG) was measured using a quantitative assay on the Luminex platform. RESULTS : From 6332 individuals in 3453 households, the overall RBD IgG seroprevalence was 19.1% [95% confidence interval (CI): 18.1–20.1%] and similar in children and adults. The seroprevalence varied from 5.5% to 43.2% across subdistricts. Conservatively, there were 2 897 120 (95% CI: 2 743 907–3 056 866) SARS-CoV-2 infections, yielding an infection rate of 19 090 per 100 000 until 9 January 2021, when 330 336 COVID-19 cases were recorded. The estimated IFR using recorded COVID-19 deaths (n = 8198) was 0.28% (95% CI: 0.27–0.30) and 0.67% (95% CI: 0.64–0.71) assuming 90% of modelled natural excess deaths were due to COVID-19 (n = 21 582). Notably, 53.8% (65/122) of individuals with previous self-reported confirmed SARS-CoV-2 infection were RBD IgG seronegative. CONCLUSIONS : The calculated number of SARS-CoV-2 infections was 7.8-fold greater than the recorded COVID-19 cases. The calculated SARS-CoV-2 IFR varied 2.39-fold when calculated using reported COVID-19 deaths (0.28%) compared with excess-mortality-derived COVID-19-attributable deaths (0.67%). Waning RBD IgG may have inadvertently underestimated the number of SARS-CoV-2 infections and conversely overestimated the mortality risk. Epidemic preparedness and response planning for future COVID-19 waves will need to consider the true magnitude of infections, paying close attention to excess-mortality trends rather than absolute reported COVID-19 deaths.The Bill and Melinda Gates Foundation.https://academic.oup.com/ijehj2023Family Medicin

Education for Social Justice and Transformation: A Mismatch between Policy and Practice in Juvenile Reformatory Schools in Zimbabwe

Few studies have directly examined juveniles’ experiences regarding their academic challenges as they go through reformatory institutions. In this study, 53 institutionalised juveniles responded to open ended interview questions by identifying and describing educational practices that affected their academic achievement. The data from this study revealed four themes of educational experiences, namely correctional curriculum, corporal punishment, recidivism and failure to re-integrate into mainstream society. The key conclusions from the data revealed there is a wide gap between juvenile re-integration expectations and the correctional curriculum that students are exposed to as they do time in the local detention facilities under study. There was a clear disconnection between the officials and how students’ valued their benefits of being detained in the institution

Modelling the Misuse of Alcohol and Drugs in South Africa Using Bayesian Binary Logistic Regression

The misuse of alcohol and drugs is a continuous life threat globally, including in South Africa. For that reason, researchers continue to investigate the risk factors associated with alcohol and drugs misuse. Most studies in literature employed the classical logistic regression model to investigate these risk factors. However, some of the issues pertaining to the classical methods are accounted for in the Bayesian framework. Likewise, the Bayesian logistic regression model can also account for problematic issues to the classical logistic regression model. Several studies used the Bayesian logistic regression model to investigate the risk factors associated with alcohol and drugs misuse. Usually, most Bayesian studies utilize default prior probability distributions such as Jeffereys’ prior and Zellner’s informative g-prior distributions. Not long ago, modified versions of Zellner’s informative g-prior distribution have been proposed. This study aims to evaluate the effectiveness of a modified Zellner’s informative g-prior distribution and subdue separation in modelling the misuse of alcohol and drugs. The model developed through the use of a modified Zellner’s g-prior distribution is compared to the models developed through the use of a hyper g-prior distribution and mixtures of g and n prior distribution. Comparisons are based on precision and average prediction error. Although the models yielded similar results, the modified version of Zellner’s informative g-prior distribution resulted in narrow credible intervals, and a small everage prediction error. Separation is also accounted for in the model. In this study, the modified version of Zellner’s informative g-prior distribution is evidently effective. All models are developed using the Bayesian adaptive sampling (BAS) R package. Further research may include evaluating some of the recommended prior distributions for the Generalised Linear Models (GLM) and comparison of Bayesian binary logistic regression developed in this study with logistic regression in Machine Learning algorithms

Impact of Age and Sex on CD4+ Cell Count Trajectories following Treatment Initiation: An Analysis of the Tanzanian HIV Treatment Database.

OBJECTIVE: New guidelines recommend that all HIV-infected individuals initiate antiretroviral treatment (ART) immediately following diagnosis. This study describes how immune reconstitution varies by gender and age to help identify poorly reconstituting subgroups and inform targeted testing initiatives. DESIGN: Longitudinal data from the outpatient monitoring system of the National AIDS Control Program in Tanzania. METHODS: An asymptotic nonlinear mixed effects model was fit to post-treatment CD4+ cell count trajectories, allowing for fixed effects of age and sex, and an age by sex interaction. RESULTS: Across 220,544 clinic visits from 32,069 HIV-infected patients, age- and sex-specific average CD4+ cell count at ART initiation ranged from 83-136 cells/mm3, long term asymptotic CD4+ cell count ranged from 301-389 cells/mm3, and time to half of maximal CD4+ reconstitution ranged from 3.57-5.68 months. CD4+ cell count at ART initiation and asymptotic CD4+ cell count were 1.28 (95% CI: 1.18-1.40) and 1.25 (95% CI: 1.20-1.31) times higher, respectively, for females compared to males in the youngest age group (19-29 years). Older patients started treatment at higher CD4+ counts but experienced slower CD4+ recovery than younger adults. Treatment initiation at greater CD4+ cell counts was correlated with greater asymptotic CD4+ cell counts within all sex and age groups. CONCLUSION: Older adults should initiate care early in disease progression because total immune reconstitution potential and rate of reconstitution appears to decrease with age. Targeted HIV testing and care linkage remains crucial for patient populations who tend to initiate treatment at lower CD4+ cell counts, including males and younger adults

A study Comparing TextBased WhatsApp and Face-to-Face Interviews to Understand Early School Dropout

The majority of adolescents communicate via text-based messaging, particularly through WhatsApp, a widely used free communication application. Written content on WhatsApp has the methodological potential to provide rich qualitative interview data. This study compares data collected using text-based WhatsApp versus face-to-face interview techniques. Semistructured interviews were conducted with a sample of early school leavers in South Africa, using WhatsApp (n = 9) and face-to-face (n = 27) followed by a focus group discussion with interviewers. Mann-Whitney U and chisquared were used to assess associations. WhatsApp text-based interviews took significantly longer to complete but were comparable to face-to-face on the number of themes generated. Rapport, measured as the number of statements from the interviewer aimed at creating a sense of affinity, comfort, and distress reduction, differed between interview conditions. It may be methodologically appropriate for researchers to offer participants a choice of a preferred method of interviewing or consider pragmatic blended approaches of face-to-face and WhatsApp

A study Comparing TextBased WhatsApp and Face-to-Face Interviews to Understand Early School Dropout

The majority of adolescents communicate via text-based messaging, particularly through WhatsApp, a widely used free communication application. Written content on WhatsApp has the methodological potential to provide rich qualitative interview data. This study compares data collected using text-based WhatsApp versus face-to-face interview techniques. Semistructured interviews were conducted with a sample of early school leavers in South Africa, using WhatsApp (n = 9) and face-to-face (n = 27) followed by a focus group discussion with interviewers. Mann-Whitney U and chisquared were used to assess associations. WhatsApp text-based interviews took significantly longer to complete but were comparable to face-to-face on the number of themes generated. Rapport, measured as the number of statements from the interviewer aimed at creating a sense of affinity, comfort, and distress reduction, differed between interview conditions. It may be methodologically appropriate for researchers to offer participants a choice of a preferred method of interviewing or consider pragmatic blended approaches of face-to-face and WhatsApp