The accessibility to oral health services in Lesotho’s public health sector

Lesotho is a land-locked mountainous country in Southern Africa. Both geography and poverty impact on dental health in low-income patients. Information on the number and function of dentists and dental therapists in public hospitals, are lacking. The aim was to investigate accessibility to oral health services. Objectives were to investigate the number and geographical distribution of oral health personnel and document the availability of dental services in Lesotho. A cross-sectional mixed methods study design was used. Four dental therapists of the six employed by the government, participated in in-depth interviews. Questionnaires about access to oral health services were administered to government employed dentists. The Lesotho National Department of Oral Health provided information regarding dental patient statistics between 2017 and 2019. It was found that 20 dentists and 10 dental therapists provided limited dental services in public facilities. In 2017, 2018 and 2019; the annual numbers of dental patients were 85 776, 75 148 and 97 425 respectively. Approximately 40% of patients visited two hospitals in Maseru. It was concluded that there was a shortage of oral health personnel, resulting in inadequate access to dental services, particularly in rural areas

The Socio-Economic Benefit of the Livestock Traceability System on Communal Beef Farmers in Swaziland

In this article, Swaziland is placed in the forefront as a small African country that implemented a livestock traceability system to benefit both communal and commercial farmers. The communal farmers are also able to export beef to European countries, markers that were previously unavailable to them, due to the successful implementation of the Swaziland Livestock Information and Traceability System (SLITS).  Livestock traceability is briefly explained to align it with the importance of safe food production for human consumption and a few aspects are highlighted. The traceability systems is further explained in terms of its benefit to the rural economy, its role in growing the GDP and the realization of its aims as was initially expected by the Swazi Government. The data collection methods used were a document review, a case study and five interviews. It is concluded that livestock traceability systems should be adopted wider by other developing countries as it has a direct effect on the improvement of the socio-economic conditions of the rural poor. Its development and implementation remains very expensive, but Swaziland can be used as an example of a country that is able to reap the rewards from a commodity that is ample in their country, but scarce globally, leading to wider food sustainability

Using participatory risk analysis to develop a song about malaria for young children in Limpopo Province, South Africa

Abstract Background In 2015, malaria infected over 212 million people and killed over 429,000 individuals, mostly children under 5 years of age, with 90% of malaria cases occurring in sub-Saharan Africa. The aim was to develop an age and culturally appropriate song for Tshivenda-speaking children under 5 years of age to decrease the risk of malaria in Limpopo Province, South Africa. Methods Document review was used to identify appropriate disease determinants to decrease risk in children < 5 years old in the study area. These were used to develop lyrics and music for a song about malaria in line with the principles of participatory risk analysis. The age and cultural appropriateness of the song as well as disease determinants chosen were reviewed using a modified Delphi technique, by 10 purposively selected experts in malaria (4), Vhavenda music (3) and early childhood education (3). Thereafter, the song was translated into Tshivenda and reviewed by two focus groups living in the study area, one including female caregivers and pre-school teachers (n = 7) and a second comprising of male community based malaria control personnel (n = 5). Results The experts surveyed and both focus groups strongly supported the inclusion of knowledge about the link between mosquitoes and malaria and that children should know the signs of malaria to facilitate early diagnosis. Although the expert group felt that bed nets should not be mentioned, both focus groups suggested the inclusion of bed nets and it was observed that community members were purchasing their own nets. Focus group members also felt that young children should not be involved in internal residual spraying initiatives. Conclusions It was concluded that although risk communication on malaria prevention and treatment in young children should be aimed at caregivers, an age and culture appropriate song about malaria could be developed to help young children protect themselves. This song focused on understanding the link between mosquitoes and malaria, preventing exposure and recognising signs of disease

Investigation of the food value chain of ready-to-eat chicken and the associated risk for staphylococcal food poisoning in Tshwane Metropole, South Africa

The objective of the study was to better understand the informal markets for ready-to-eat (RTE) chicken in Tshwane Metropole, Gauteng Province, South Africa, and in particular the links between the formal and informal sector. As part of this, we assessed the risk of a common food poisoning (staphylococcal) through consumption of RTE chicken sold by informal vendors. We used participatory risk assessment, a novel approach to understanding food safety in data scarce environments to collect information. Structured interviews and focus group discussions with informal vendors (n = 237) were conducted to understand poultry value chains for informal RTE chicken, business operation and hygiene practices. Samples (n = 100) of RTE were collected from informal vendors in six major taxi ranks. Staphylococcus aureus counts were determined using 3M^ Petrifilm^ plates. Data collected in this present study plus information obtained from reviewing of literature, were used to develop a stochastic risk model. The number of colonies which were too numerous to count (TNTC) was artificially modeled. A mapping of the informal food value chain revealed that there are four possible value chains and that chicken spilled over from formal to informal markets. The prevalence of S. aureus in RTE chicken samples (44%; 90% CI: 36.1%-52.2%) was high. The mean S. aureus counts in the ready to eat chicken was 10^ (90%CI: 10^3-10^), and the risk of purchasing chicken of unsatisfactory quality (>10^3 cfu/g) was 32.9% (90%CI: 25.5%-40.4%). The probability of food poisoning due to consumption of RTE chicken contaminated with staphylococcal enterotoxin was estimated to be 1.3% (90% CI: 0%-2.7%). Sensitivity analysis showed that the probability of S. aureus having the enterotoxin gene was the most sensitive parameter for food poisoning. This was followed by S. aureus concentration in RTE chicken and lastly the prevalence of S. aureus in ready-to-eat chicken. This study demonstrates the existence of a strong link between formal and the informal market. In view of the low risk observed, the relevant authorities in Tshwane should continue to support the informal sale of RTE chicken. However, there is still a need for provision of hygiene training to reduce the concentration levels of S. aureus on the RTE chicken, and to promote the sale of safer affordable source of protein for the large urban poor population in South Africa. This will also help secure the opportunities for employment associated with the trade

Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design

Importance: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. Methods: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. Discussion: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options