Developing district health systems in the rural Transvaal Issues arising from the Tintswalo/Bushbuckridge experience

District health systems are increasingly acknowledged as a foundation for national health services based on primary health care. Initial efforts to institute a demonstration district health system in the Bushbuckridge area of the eastern Transvaal are described. These include efforts to overcome the organisational and administrative fragmentation caused by homeland and provincial boundaries. Close attention needs to be given to districtlevel health management, the complementary roles of district and regional health authorities, working relationships and accountability among professional staff from different disciplines, involvement of the community in a district health authority and the district health system as an element oflocal government

Vikela Ekhaya: A Novel, Community-Based, Tuberculosis Contact Management Program in a High Burden Setting

BACKGROUND: The prevention of tuberculosis (TB) in child contacts of TB cases and people living with human immunodeficiency virus (HIV) is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT. METHODS: Vikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases by using mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants\u27 homes. RESULTS: In total, 945 contacts from 244 households were screened for TB symptoms; 72 (8%) contacts reported TB symptoms, and 5 contacts (0.5%) were diagnosed with prevalent TB. A total of 322 of 330 (98%) eligible asymptomatic household contacts initiated TPT. Of 322 contacts initiating TPT, 248 children initiated 3 months of isoniazid and rifampicin and 74 children and adults living with HIV initiated 6 months of isoniazid; 298 (93%) completed TPT. In clustered logistic regression analyses, unknown HIV status (adjusted odds ratio [aOR] 5.7, P = .023), positive HIV status (aOR 21.1, P = .001), urban setting (aOR 5.6, P = .006), and low income (aOR 5.9, P = .001) predicted loss from the cascade of care among TPT-eligible contacts. CONCLUSION: Vikela Ekhaya demonstrated that community-based TB household contact management is a feasible, acceptable, and successful strategy for TB screening and TPT delivery. The results of this study support the development of novel, differentiated, community-based interventions for TB prevention and control

Revival of the magnetar PSR J1622-4950: observations with MeerKAT, Parkes, XMM-Newton, Swift, Chandra, and NuSTAR

New radio (MeerKAT and Parkes) and X-ray (XMM-Newton, Swift, Chandra, and NuSTAR) observations of PSR J1622-4950 indicate that the magnetar, in a quiescent state since at least early 2015, reactivated between 2017 March 19 and April 5. The radio flux density, while variable, is approximately 100x larger than during its dormant state. The X-ray flux one month after reactivation was at least 800x larger than during quiescence, and has been decaying exponentially on a 111+/-19 day timescale. This high-flux state, together with a radio-derived rotational ephemeris, enabled for the first time the detection of X-ray pulsations for this magnetar. At 5%, the 0.3-6 keV pulsed fraction is comparable to the smallest observed for magnetars. The overall pulsar geometry inferred from polarized radio emission appears to be broadly consistent with that determined 6-8 years earlier. However, rotating vector model fits suggest that we are now seeing radio emission from a different location in the magnetosphere than previously. This indicates a novel way in which radio emission from magnetars can differ from that of ordinary pulsars. The torque on the neutron star is varying rapidly and unsteadily, as is common for magnetars following outburst, having changed by a factor of 7 within six months of reactivation.Comment: Published in ApJ (2018 April 5); 13 pages, 4 figure

Advancing a holistic systems approach for sustainable cattle development programmes in South Africa: insights from sustainability assessments

Efforts to exploit the central roles of cattle to drive agriculture and rural development in low-income countries recorded limited success owing to their narrow focus on modernizing and commercializing low-input cattle farming. Most programs failed to take cognizance of the heterogeneous range of complex relationships between the environmental, economic, social and institutional challenges that limit low-input cattle farming. The current qualitative literature review evaluates the environmental, economic and social sustainability delivery impacts of the leading cattle development programs in the low-input farming sector in South Africa using a holistic systems approach. A mixed method procedure involving stratified sampling was used to allocate local and international-based programs while, purposive sampling was used to select programs with a wider scale of operation. The review then draws on the crosscutting key constraints emerging from the case studies to provide a better grounding for subsequent sustainability sensitive recommendations. Local-based cattle development programs advanced more market-led interventions while, their international-based counterparts had more interventions including, soil and rangeland improvement. The narrow focus by both local and international developmental programs is inadequate to address a wide array of environmental, economic, social, technical and institutional challenges faced by low-input cattle producers in South Africa.The Department of Science and Technology-National Research Foundation (DST-NRF) Centre of Excellence (CoE) in Food Security [140102].https://www.tandfonline.com/loi/wjsa212021-01-23hj2020Gordon Institute of Business Science (GIBS