Human papillomavirus (HPV) vaccination of adolescents in the South African private health sector: Lessons from the HPV demonstration project in KwaZulu-Natal

In South Africa (SA), >4 000 women die annually of cervical cancer, a disease caused by the human papillomavirus (HPV). Infections caused by certain genotypes of HPV increase the risk of cervical cancer. HIV-infected women in particular are more likely to have persistent HPV infection, with higher-risk genotypes. In SA, two vaccines (HPV quadrivalent (types 6, 11, 16, and 18) vaccine, recombinant (Gardasil) and HPV bivalent (types 16 and 18) vaccine, recombinant (Cervarix)) are currently registered for the prevention of HPV-related disease. In the past, there have been significant challenges to achieving high coverage and uptake of vaccination – contributory factors include cost and lack of awareness. An HPV demonstration project among schoolgirls in rural KwaZulu-Natal showed that high vaccine uptake is achievable. In 2014, the National Department of Health launched the national HPV vaccination programme among female learners attending public schools. Awareness of HPV vaccination among healthcare providers, education of parents, teachers and learners, and avoidance of missed opportunities for vaccination are vital to the success of the programme. Primary healthcare practitioners may play an important role in cervical cancer prevention by identifying and offering vaccination to girls who miss the opportunity to be vaccinated at school. HPV vaccination should be considered as one arm of a comprehensive programme of cervical cancer prevention and control

Utilising the Healy and Jenkin’s Research Teaching and Curriculum Design Nexus to transform undergraduate nursing research communities of practice

In science, research is known to be a diligent systematic inquiry into nature and society or both. It assists in validating and refining existing knowledge and generating new knowledge. Lecturers and scholars have embraced the integration of evidence-based practice into the nursing education curriculum in numerous ways. Although the learning competencies necessary for research competencies amongst undergraduate nurses include an understanding of the basic concepts and processes of research methods, it does not adequately support student preparedness for the attainment of postgraduate research competencies. The design of this study adopted a qualitative, exploratory and descriptive course of enquiry that explored current pedagogical research practices amongst lecturers and supervisors. A case study approach utilising, specifically, a cross-case analysis helped provide a clear picture of institutional pedagogical practices related to the topic of inquiry and its implementation thereof. The cases from approved local, national and international higher education institutions formed the setting for the study. Lecturers facilitating and supervising undergraduate and postgraduate research studies comprised the target population of a purposive sampling selection. In this study, the authors utilised the Healey and Jenkins Teaching Nexus to show that the research engagement of students and nursing research communities of practice can be strengthened if embraced by sound pedagogical practices. The Nexus outlines four concepts that guide the pedagogical practice of the research module that promotes undergraduate students as researchers. The authors of this article concluded that it was necessary to engage students as producers and not merely as consumers of knowledge. In this study, the researchers also utilised the Nexus to show students’ engagement in fostering different teaching approaches to research knowledge acquisition

‘A stitch in time…may save nine’: A systematic synthesis of the evidence for domestic violence management and prevention in Emergency Care

The aim of this policy brief is to provide an evidence-informed answer to the question: ‘What is the role and scope of pre-hospital emergency care providers to domestic violence (DV) intervention as a form of gender-based violence prevention?’ The answer is intended to determine the theoretical and clinical best practice to inform the emergency care community and policy development by critically appraising the evidence that considers the responsiveness of Emergency Medical Services to the health needs of DV victims. Evidence-informed Decision Making methods are employed. The evidence appraised was based on electronic searchesusing the Cape Peninsula University of Technology database. Research and non-research publications were considered with publication dates mostly from 1999 to 2011. Upon screening 164 articles for content relevance, 53 were critically appraised against predetermined criteria for relevance of the evidence, robust nature of the evidence and presence of bias. A thematic/narrative analysis ensued in terms of strength of evidence and frequency of findings. Early recognition and intervention is seen as one of the most effective methods of DV prevention. This finding is nuanced if it is male caregivers doing so. There is an ethical obligation to implement a comprehensive health approach to manage domestic violence victims. The strong, majority findings are that educational intervention/s increases the health care provider’s understanding of DV and improves screening for DV. The research supports the development and use of screening tools/guidelines/ procedures for DV as they are found to improve DV intervention. The evidence supports an integrated effort of the health system in achieving its goal of DV prevention by promoting the participation of pre-hospital emergency care providers as critical stakeholders.Key words: Domestic Violence (DV) management and prevention, Emergency Care Providers (ECP’s), Gender-based violence (GBV) prevention, Evidence-informed Decision Making (EiDM), Emergency Medical Servic

Incisional Hernia: Experience in a single surgical unit

Background: Incisional hernias are a common problem in general surgery and they have a varied aetiology. The aim of this study was to document a single unit experience with the management of incisional hernias at King Edward VIII Hospital, Durban, South Arica.Patients and Methods: This was a prospective audit of incisional hernias in a single surgical unit from January 2001 to May 2004. All patients underwent open repair. Clinical data and intra-operative findings were documented.Results: A total number of 77 patients were seen of which 70 were female. Fifty three (68.8%) and 24 (31.2%) of patients underwent elective and emergency surgery respectively. A total of 56 patients had previously undergone gynaecological surgery compared to 21 who had undergone general surgery. There was a documented history of previous sepsis in 4 (7%) of patients. There was 1 sheath defect in 36 patients, 2 defects in 9 patients, 3 defects in 10 patients, 4 or more defects in 9 cases. In 55 patients the original suture could not be identified. Gangrenous bowel was present in 3 patients. Only 3 (3.9%) of the patients had a mesh repair. The rest (96.1%) underwent tissue repair. Morbidity rate was 17% and there were no deaths. Five patients needed management in the ICU. Hospital stay was 8 + 11 yearsConclusion: Most incisional hernias followed gynaecological surgery. There was no evidence of a nonabsorbable suture having been used at the original operation in over half of the patients. We recommend that meticulous technique is essential in closing the abdominal incision

Interleukin 1-Beta (IL-1) Production by Innate Cells Following TLR Stimulation Correlates With TB Recurrence in ART-Treated HIV-Infected Patients

BACKGROUND: Tuberculosis (TB) remains a major cause of global morbidity and mortality, especially in the context of HIV co-infection, since immunity is not completely restored following antiretroviral therapy (ART). The identification of immune correlates of risk for TB disease could help in the design of host-directed therapies and clinical management. This study aimed to identify innate immune correlates of TB recurrence in HIV+ ART-treated individuals with a history of previous successful TB treatment. METHODS: Twelve participants with a recurrent episode of TB (cases) were matched for age, sex, time on ART, pre-ART CD4 count with 12 participants who did not develop recurrent TB in 60 months of follow-up (controls). Cryopreserved peripheral blood mononuclear cells from time points prior to TB recurrence were stimulated with ligands for Toll like receptors (TLR) including TLR-2, TLR-4, and TLR-7/8. Multi-color flow cytometry and intracellular cytokine staining was used to detect IL-1β, TNF-α, IL-12 and IP10 responses from monocytes and myeloid dendritic cells (mDCs). RESULTS: Elevated production of IL-1β from monocytes following TLR-2, TLR-4 and TLR-7/8 stimulation was associated with reduced odds of TB recurrence. In contrast, production of IL-1β from both monocytes and mDCs following Bacillus Calmette-Guérin (BCG) stimulation was associated with increased odds of TB recurrence (risk of recurrence increased by 30% in monocytes and 42% in mDCs respectively). CONCLUSION: Production of IL-1β by innate immune cells following TLR and BCG stimulations correlated with differential TB recurrence outcomes in ART-treated patients and highlights differences in host response to TB

A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa

Introduction: Tuberculosis (TB) remains the most common cause of death among people living with HIV. Integrating HIV and TB services reduces mortality but is sub-optimally implemented. Quality improvement (QI) methods offer a low-cost and easily implementable approach to strengthening healthcare delivery systems. This trial assessed a QI intervention on key process indicators for delivering integrated HIV-TB care in rural South African primary healthcare (PHC) clinics. Methods: Sixteen nurse supervisors, (each with a cluster of clinics) overseeing 40 PHC clinics, were randomized 1:1 to the intervention or the standard of care (SOC) groups. The QI intervention comprised three key components: clinical and QI skills training, on-site mentorship of nurse supervisors and clinic staff, and data quality improvement activities to enhance accuracy and completeness of routine clinic data. The SOC comprised monthly supervision and data feedback meetings. From 01 December 2016 to 31 December 2018, data were collected monthly by a team of study-appointed data capturers from all study clinics. This study's outcomes were HIV testing services (HTS), TB screening, antiretroviral therapy (ART) initiation, isoniazid preventive therapy (IPT) initiation and viral load (VL) testing. Results: The QI group (eight clusters) comprised 244 clinic staff who attended to 13,347 patients during the trial compared to the SOC group (eight clusters) with 217 clinic staff who attended to 8141 patients. QI mentors completed 85% (510/600) of expected QI mentorship visits to QI clinics. HTS was 19% higher [94.5% vs. 79.6%; relative risk (RR)=1.19; 95% CI: 1.02–1.38; p=0.029] and IPT initiation was 66% higher (61.2 vs. 36.8; RR=1.66; 95% CI: 1.02–2.72; p=0·044), in the QI group compared to SOC group. The percentage of patients screened for TB (83.4% vs. 79.3%; RR=1.05; p=0.448), initiated on ART (91.7 vs. 95.5; RR=0.96; p=0.172) and VL testing (72.2% vs. 72.8%; RR=0.99; p=0.879) was similar in both groups. Conclusions: QI improved HIV testing and IPT initiation compared to SOC. TB screening, ART initiation and VL testing remained similar. Incorporating QI methods into routine supervision and support activities may strengthen integrated HIV-TB service delivery and increase the success of future QI scale-up activities

A comparative study of multiple imputation and subset correspondence analysis in dealing with missing data

Methods: Multiple imputation and subset correspondence analysis are applied to a set of child asthma data that is mainly categorical and suffers from non-response. Differences in the methods and in the outcomes they produce are studied. In addition, the inclusion of interactions in a subset correspondence analysis is illustrated. Results: Despite the vast differences in the two approaches, they yielded similar results in the identification of genetic, environmental and socio-economic factors that affect childhood asthma. A number of exposure related variables were found to be associated with the greater severity of asthma. It was also found that a finer distinction between the asthma severity levels and their associations with factors was possible with a subset correspondence analysis, compared to the multiple imputation approach. Conclusions: Both multiple imputation and subset correspondence analysis were able to identify several factors associated with childhood asthma while at the same time successfully managing the missing data. This offers the researcher a choice to select the method that best suits his/her study

A review of ambient air pollution exposure assessment methods in determining childhood respiratory health effects in children under five

Various epidemiological studies have reported on air pollution exposure-related lung function decline and respiratory health effects in children. Children have increased susceptibility to ambient air pollutants as physiological and structural changes of the lung are still occurring within the first five years of life after birth. This review examines applications in air pollution exposure assessment methods when evaluating lung function and respiratory health concentration-response effects in young children, while considering the effects of critical windows of exposure. We identified 13 studies that used various methods of exposure assessment in assessing respiratory health outcomes (presence of lower respiratory tract infections, respiratory symptoms, wheezing and asthma) in children under five. The methods applied included personal monitoring (n = 1), proximity-based methods (n = 3), inverse distance weighting (n = 2), geographic weighted regression (n = 1), dispersion modeling (n = 1), satellite-based methods (n = 2) and land use regression modeling (n = 5). These studies assessed exposure and outcomes at different "windows of susceptibility": antenatally/specific trimesters (n = 8), infancy (n = 5) and early childhood (n = 6). In most studies, the reported measures of air pollutants were noted to be below the prescribed limits, though for some, a cause-effect association was observed. It was also noted that there was very little variation in estimates between time points or trimesters of exposure, likely attributed to limitations in the selected exposure assessment method. Moderate to high correlations between trimesters were reported for most studies. © 2022 by the authors

South African surgical registrar perceptions of the research project component of training: Hope for the future?

Background. The Health Professions Council of South Africa requires that a research project be submitted and passed before registration as a specialist.Objective. To describe surgical registrars’ perceptions of the compulsory research project.Method. Ethics clearance was received before commencing the study. A questionnaire was developed to collect feedback from surgical registrars throughout South Africa (SA). Completed questionnaires underwent descriptive analysis using MS Excel. Fisher’s exact test and the χ2 test were used to compare perceptions of the research-experienced and research-naive groups.Results. All medical schools in SA were sampled, and 51.5% (124/241) of surgical registrars completed the questionnaire. Challenges facing registrars included insufficient time (109/124), inadequate training in the research process (40/124), inadequate supervision (31/124), inadequate financial resources (25/124) and lack of research continuity (11/124). Of the registrars sampled, 67.7% (84/124) believed research to be a valuable component of training. An overwhelming percentage (93.5%, 116/124) proposed a dedicated research block of time as a potential solution to overcoming the challenges encountered. Further proposals included attending a course in research methodology (79/124), supervision by a faculty member with an MMed or higher postgraduate degree (73/124), and greater research exposure as an undergraduate (56/124). No statistically significant differences were found between the perceptions of the researchexperienced and research-naive groups.Conclusions. Challenges facing surgical registrars in their efforts to complete their research projects were identified and solutions to these problems proposed. It is heartening that respondents have suggested solutions to the problems they encounter, and view research as an important component of their careers