Cotrimoxazole Prophylaxis and Risk of Severe Anemia or Severe Neutropenia in HAART-Exposed, HIV-Uninfected Infants

Background: Prophylactic cotrimoxazole is recommended for infants born to HIV-infected mothers. However, cotrimoxazole may increase the risk of severe anemia or neutropenia. Methods: We compared the proportion of HIV-exposed uninfected (HIV-EU) infants experiencing incident severe anemia (and separately, severe neutropenia) between a prospective cohort receiving prophylactic cotrimoxazole from 1 to 6 months vs. infants from two prior trials who did not receive cotrimoxazole. Infants were from rural and urban communities in southern Botswana. Results: A total of 1705 HIV-EU infants were included. Among these 645 (37.8%) were fed with iron-supplemented formula from birth. Severe anemia developed in 87 (5.1%) infants, and severe neutropenia in 164 (9.6%) infants. In an analysis stratified by infant feeding method, there were no significant differences in the risk of severe anemia by prophylactic cotrimoxazole exposure–risk difference, −0.69% (95% confidence interval [CI] −2.1 to 0.76%). Findings were similar in multivariable analysis, adjusted odds ratio (aOR) 0.35 (95% CI 0.07 to 1.65). There were also no significant differences observed for severe neutropenia by cotrimoxazole exposure, risk difference 2.0% (95% CI −1.3 to 5.2%) and aOR 0.80 (95% CI 0.33 to 1.93). Conclusions: Severe anemia and severe neutropenia were infrequent among HIV-exposed uninfected infants receiving cotrimoxazole from 1–6 months of age. Concerns regarding hematologic toxicity should not limit the use of prophylactic cotrimoxazole in HIV-exposed uninfected infants. ClinicalTrials.gov Registration Numbers NCT01086878 (http://clinicaltrials.gov/show/NCT01086878), NCT00197587 (http://clinicaltrials.gov/show/NCT00197587), and NCT00270296 (http://clinicaltrials.gov/show/NCT00270296)

Linguistic challenges faced by Grade 7 Setswana learners when writing Science examinations in English

The paper investigates the linguistic challenges faced by Setswana-speaking Grade 7 learners when writing Science examinations in English. In South African schools, non-mother tongue speakers of English learners are only introduced to English as a language of learning and teaching in Grade 4, which creates problems for these learners because English is foreign to them. The purpose of conducting this research was to help policymakers meet the linguistic needs of non-native English speakers, make curriculum development specialists aware of the linguistic challenges faced by non-native speakers of English and help readers gain a better understanding of why some teachers prefer to use indigenous languages when they teach in English. The participants comprised four purposively selected Grade 7 Natural Science teachers, two school governing bodies (SGBs) and Grade 7 learners from two primary schools in Hammanskraal, Gauteng. Data gathered indicated that Setswana-speaking learners made basic errors related to spelling, sentence construction, grammar, incomplete sentences, mixed languages, using words that do not exist, tenses and understanding instructions. As a result, SGBs should consider these linguistic challenges when they draft language policies for rural and township schools

COVID-19 and the Quest for Reconfiguration of Disciplines: Unpacking New Directions

This theoretical editorial piece sets the tone for a special issue that focuses on teasing new directions during and after the COVID-19 pandemic. The piece is underpinned by bricolage thinking, and we seek to show that it is essential to reimagine various educational disciplines in order to meet new challenges and opportunities presented by COVID-19. In doing so, we are convinced that the relationship between a serene scholarly quest and applied space has to be re-examined. Thus, to reimagine a better world during and post COVID-19, cross-disciplinarity is no longer an option for humanity, instead, it is essential, to ensure the collective efforts needed to address the pressing issues of the day. We end this editorial section by arguing that new strategies that are adopted need to be shared across disciplines and faculties, to reinvent multidisciplinary or interdisciplinary approaches to addressing human crises

Patients’ perceptions on reluctance to undergo cataract surgery in Sedibeng district hospital, Gauteng province

Background: Over 50 million people are blind, and 135 million people suffer from severe visual impairments, with cataracts contributing to 51% of global blindness cases. Despite efforts to promote cataract surgery (CS), many patients remain hesitant, underscoring the importance of understanding their perspectives. Aim: This study aimed to explore and describe patients’ perceptions regarding reluctance to undergo CS to improve awareness and increase surgery uptake. Setting: The research was conducted in the Sedibeng District, Gauteng province, South Africa. Methods: A qualitative descriptive phenomenological design was employed to capture the lived experiences of patients through face-to-face, individual semi-structured interviews with 15 patients aged 38 – 72 years prior to their CS. Purposive sampling was used to select participants, and Colaizzi’s seven-step analysis was used for data analysis. Results: The findings highlight several barriers perceived by participants, including long waiting times; fear; lack of knowledge; limited financial, material and human resources; power outages; uncontrolled blood sugar levels; and coronavirus disease 2019 (COVID-19) pandemic restrictions. Nevertheless, some view it positively as a means to avert blindness and enhance vision. Conclusion: To address the challenges, the study recommends boosting the number of eye health care professionals, prioritising budget allocation, addressing electricity interruptions and conducting community outreach educational programmes to improve access to CS in the district. Contribution: The insights gained from this study can help health care providers and policymakers optimise care and support for CS patients through policy formulation and education. Addressing these knowledge gaps will likely increase surgery uptake and improve patients’ quality of life

Toward Sustainable Conservation and Management of Human-wildlife Interactions in the Mmadinare Region of Botswana: Villagers’ Perceptions on Challenges and Prospects

Human–wildlife conflicts are increasing globally. The increase in conflicts has been attributed to growing human and wildlife populations and a per capita increase in the consumption of natural resources. In Botswana, conflicts between humans and elephants (Loxodonta africana) are increasing. The growing human population (2.2 million) is encroaching on the animals’ already restricted range. Concomitantly, more elephants are adversely affecting arable agriculture production. To better understand the magnitude and intensity of human–wildlife interactions with elephants and other native wildlife species in Botswana, we collected data through community forum conducted July 17–18, 2017 at a “Kgotla” meeting in Mmadinare, a village in the Central District of Botswana. Mmadinare has experienced increased human–wildlife conflicts, mainly related to elephants. The Kgotla is the traditional community meeting place in Botswana villages. The Kgotla provides for freedom of expression, transparent debate, officialdom, and is the official seat for the village leaders. Issues discussed at the Kgotla are highly regarded, and individuals who have discussions do so seriously. Although the forum was our main data collection method, we also used personal anecdotes that communicated participants’ emotional encounters with elephants, their helplessness to deal with elephants, failure of traditional management approaches, and their concerns regarding the lack of government support. The research team members and forum participants who had been impacted most by the wildlife also visited the affected areas. Despite the increasing damage, the community emphasized that harmonious coexistence is desirable and sustainable. One strategy highlighted to lead to harmonious living with elephants was the establishment of a wildlife educational park. The option was attractive because the community expressed strong ownership of the concept. Their perspectives reinforced the gravity and urgency of the situation and the importance of working out intentional strategies to positively direct and manage human–wildlife interactions

Material compatible nano modified emulsion(MC-NME) technologies in slurry design and applications for road surfacings

Papers presented virtually at the 42nd International Southern African Transport Conference on 08 - 11 July 2024The use of slurries as an alternative surfacing and maintenance option is well established within the South African roads industry. Following the successful use of anionic Material Compatible Nano Modified Emulsions (MC-NME) for the stabilisation of granular pavement layers, the question was raised whether the same technology could be used to improve the properties of cost-effective surfacings, with specific reference to cost-effective, labour- intensive slurries. The first test section using a slurry containing a modified binder without a cement filler comprising of an anionic Material-Compatible Nano Modified Emulsion (MC-NME) binder without any cement additive as part of a Cape seal, was done in 2018 This MC-NME slurry, based on normal slurry mix design principles, was done in order to test the viability of such an modified binder, while optimising the labour component for road surfacing using rudimentary concrete mixers next to the site of operation and minimum training to achieve the required mix. Subsequently, a laboratory investigation was done to compare test results using a single granular material source to quantify any potential benefits to be achieved using a MC-NME binder in a slurry mix. This paper gives the results of the first comparative tests done on a slurry mix, comparing a MC-NME binder slurry mix to a conventional slurry mix. The results from these initial tests show a considerable increase in several performance properties of a slurry prepared using a MC-NME binder as measured in a laboratory. (e.g. increase in tensile strength). These results give ample motivation for a more comprehensive investigation to fully comprehend and quantify the potential benefits from using a MC-NME binder in a slurry mix and to establish design criteria for MC-NME modified binder slurries

Catalytic reduction of 4-nitrophenol and methylene blue by biogenic gold nanoparticles synthesized using Carpobrotus edulis fruit (sour fig) extract

Along with the increasing requirement for efficient organic conversions using green chemistry, there is a need to develop highly efficient and eco-friendly catalytic reaction systems. Gold nanoparticles (AuNPs)-based nanocatalysts are promising candidates for the reduction of environmental pollutants, such as nitroaromatics and dyes. This study reports on the green synthesis of AuNPs using Carpobrotus edulis (C. edulis) fruit aqueous extract (CeFE) and their catalytic activities. The CeFE induced rapid reduction of gold (III) salt to form monodispersed and spherical AuNPs, with a core and hydrodynamic sizes of 40 and 108.7 nm, respectively. CeFE alone had no effect on 4-nitrophenol, whereas incubation with methylene blue (MB) caused reduction of the peak at 665 nm. Addition of CeFE-AuNPs in the presence of NaBH4, caused the reduction of 4-nitrophenol to 4-AP, and MB to leucoMB within 10 min. These reactions followed the pseudo first-order kinetics. Therefore, biogenic CeFE-AuNPs could be used for the elimination of noxious environmental pollutants

Farmer’s perception of climate change and responsive strategies in three selected provinces of South Africa

The world has responded to climate change phenomenon through two broad response mechanisms (mitigation and adaptation strategies) with the aim of moderating the adverse effects of climate change and/or to exploit any arising beneficial opportunities. The paper aims to examine the trend in climate parameters, farmers’ perception of climate change, constraints faced in production and to identify the strategies (if any) that farmers have adopted to cope with the effects of changing climate. A one-way analysis of variance, percentage analysis and Garrett ranking technique were applied to a set of primary data collected from 150 randomly sampled farmers with the aid of questionnaires in three purposively selected provinces through the months of June to August 2015. The analytical results of obtained recent weather data revealed that the climate parameters have significantly changed over time and these were substantiated by farmers’ experiences. The farmers are engaging in various climate-response strategies, among which, the planting of drought-tolerant varieties is most common. Therefore, it is important to enhance farmers’ access to improved drought-tolerant seeds and efficient irrigation systems. Also observed, is that the lack of awareness of insurance products and inability to afford insurance premiums were the principal reasons majority of the farmers did not have insurance. These present a need to strengthen insurance adoption among farmers through various supporting programmes that may include premium subsidies and media outreach. The paper under one platform provides evidence of changing climate, farmers’ responses towards mitigating perceived adverse effects of the changed climate, and South Africa’s national policy on adaptation and mitigation.Agriculture, Animal Health and Human Ecolog

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings

Background: Cross-sectional screening programs are used to detect and refer individuals with non-communicable diseases to healthcare services. We evaluated the positive predictive value of cross-sectional measurements for Diabetes Mellitus (DM) and hypertension (HTN) as part of a community-based disease screening study, ‘Vukuzazi’ in rural South Africa. Methods: We conducted community-based screening for HTN and DM using the World Health Organization STEPS protocol and glycated haemoglobin A1c (HbA1c) testing, respectively. Nurses conducted follow-up home visits for confirmatory diagnostic testing among individuals with a screening BP above 140/90 mmHg and/or HbA1c above 6.5% at the initial screen, and without a prior diagnosis. We assessed the positive predictive value of the initial screening, compared to the follow up measure. We also sought to identify a screening threshold for HTN and DM with greater than 90% positive predictive value. Results: Of 18,027 participants enrolled, 10.2% (1,831) had a screening BP over 140/90 mmHg. Of those without a prior diagnosis, 871 (47.6%) received follow-up measurements. Only 51.2% (451) of those with completed follow-up measurements had a repeat BP>140/90 mmHg at the home visit and were referred to care. To achieve a 90% correct referral rate, a systolic BP threshold of 192 was needed at first screening. For DM screening, 1,615 (9.0%) individuals had an HbA1c > 6.5%, and of those without a prior diagnosis, 1,151 (71.2%) received a follow-up blood glucose. Of these, only 34.1% (395) met criteria for referral for DM. To ensure a 90% positive predictive value i.e. a screening HbA1c of >16.6% was needed. Conclusions: A second home-based screening visit to confirm a diagnosis of DM and HTN reduced health system referrals by 48% and 66%, respectively. Two-day screening programmes for DM and HTN screening might save individual and healthcare resources and should be evaluated carefully in future cost effectiveness evaluations