Mandrax use, sexual risk, and opportunities for pre-exposure prophylaxis among out-of-school adolescent girls and young women in Cape Town, South Africa

Background. In South Africa (SA), adolescent girls and young women (AGYW) aged 15 - 24 years account for nearly 25% of all new HIV infections in the country. The intersection of substance use and sexual risk continues to drive the HIV epidemic among AGYW. For example, methaqualone, also known as Mandrax, has sedative effects that may affect women’s ability to negotiate condom use during sex, refuse sex without a condom, or consent to sex, thereby increasing their risk for HIV. Consequently, it is critical to understand how Mandrax use affects HIV risk among AGYW and to assess awareness of and willingness to use biomedical HIV prevention methods, such as pre-exposure prophylaxis (PrEP), among AGYW who use Mandrax.Objectives. To examine the role of Mandrax use in sexual behaviours and investigate the extent to which AGYW who use Mandrax are aware of and willing to initiate PrEP.Methods. Data for this report were derived from baseline and 6-month follow-up data provided by 500 AGYW participating in a cluster-randomised trial assessing the efficacy of a young woman-focused intervention to reduce substance use and HIV risk. AGYW who self-identified as black African or coloured, reported using substances, reported condomless sex in the past 3 months, and had discontinued school early were recruited from 24 community clusters across Cape Town, SA. Following consent/assent, participants provided biological specimens to test for recent drug use (including Mandrax) and completed the self-report questionnaire.Results. Logistic regression analysis revealed that the AGYW who had a positive test result for Mandrax use were less likely to use a condom with their main partner (p=0.01), and almost three times more likely to use alcohol and/or other drugs before or during their last act of sexual intercourse (p<0.001), compared with the AGYW who had a negative Mandrax test result. Mandrax use was not significantly related to PrEP awareness (p>0.10) or willingness to use PrEP (p>0.10), but 70% of AGYW who used Mandrax were willing to initiate PrEP.Conclusion. The study findings highlight how Mandrax use may contribute to HIV risk among SA AGYW. Key decision-makers should consider incorporating substance use prevention efforts into existing HIV reduction programmes and equip youth-friendly clinics with the resources to identify AGYW who use Mandrax and offer them PrEP

Substance use and depressive and anxiety symptoms among out-of-school adolescent girls and young women in Cape Town, South Africa

Background. There is a high prevalence of substance use among youth in South Africa (SA), and adolescent girls and young women (AGYW) experience high rates of depression and anxiety. Substance use behaviours and mental health are associated with other public health problems among AGYW such as HIV and unintended pregnancy. Therefore, understanding the relationship between substance use and mental health is imperative to improve AGYW’s health.Objectives. To examine the association between heavy drinking, marijuana, methamphetamine and methaqualone (Mandrax) use and depressive and anxiety symptoms among AGYW aged 16 - 19 years who have dropped out of school in Cape Town, SA.Methods. Data for this report come from the baseline data of 500 participants of an ongoing cluster-randomised trial assessing the efficacy of a young woman-focused intervention to reduce substance use and HIV risk. After AGYW consented/assented to participate, they completed a urine drug screen and a baseline questionnaire.Results. Logistic and negative binomial regressions, controlling for clustering at the neighbourhood level, revealed that frequency of depressive symptoms was significantly and positively related to a positive drug screen for Mandrax (β=0.07; p=0.03). All other associations between the frequency of depressive symptoms and substance use were not statistically significant (ps>0.05). The associations between frequency of anxiety symptoms and substance use were not statistically significant (ps>0.05).Conclusions. Our findings highlight the need to address substance use, especially Mandrax use and its associated risk, and depression in an integrated, youth-friendly setting

The Potential Role Played by Various Livestock Intermediate Hosts in the Transmission of Hydatidosis in Kenya

A study was conducted to determine the potential role played by cattle, sheep, goats and pigs in the transmission of hydatidosis in Kenya. The fertility and viability status of the hydatid cysts collected from these livestock intermediate hosts, at slaughter, were used in this evaluation. A cross-sectional survey was carried out in Nairobi\'s Dagoretti slaughterhouse and Ndumbu-ini, pig abattoir during routine post-mortem meat inspection. All hydatid cysts detected in cattle, sheep, goats and pigs were collected for laboratory analysis to determined by microscopic examination of harvested hydatid cysts fluid for the presence of protoscolices using the 0.1% Eosin Exclusion Test. Out of the 300carcasses of sheep, goats, and pigs examined, 7%, 8% and 5% harbored the cysts, respectively. Hydatid cysts from goats showed the highest fertility (87.5%), followed by those from cattle (81.4%), pigs (80%) and sheep (57.4%). Hydatid cysts from sheep showed the highest viability (100%), followed by those from goats with 85.7%, cattle with 68.6% and pigs 50%. Sheep and goats are the animals most commonly slaughtered for parties and other festivities where meat inspection is hardly carried out. Due to this as well as the high rates of fertility and viability showed by their cysts, sheep and goats may play a greatest role since all of the fertile hydatid cysts from this species were viable. These results indicate that in any hydatid disease control programme, sheep, goats, should be the livestock species included, if satisfactory control Hydatidosis is to be achieved in Kenya. This is because, only fertile and viable hydatid cysts are capable of transmitting hydatidosis to definitive hosts. The Kenya Veterinarian Vol. 27 2004: pp. 77-8

The Prevalence of Hydatidosis in Slaughtered Livestock in Kenya

Using the post-mortem meat inspection records available in the department of veterinary services, Kabete, a retrospective abattoir survey was carried out to determine the prevalence of hydatidosis in cattle sheep, goats and pigs for a ten-year period (1989-1998) in Kenya. The prevalence was calculated for each of the 7 provinces and the overall prevalence for 7 provinces was then calculated from the pooled provincial data. Records from North-Eastern province were not available for analysis, since the meat inspectorate services in this province have not been taken over by the Department of Veterinary services. They are still under the Ministry of Health and the records are in the custody of this ministry. The prevalence of hydatid cysts in various animal organs was determined. Cattle showed the highest overall prevalence (50.4%), followed by sheep with 48.8%, goats with 34.3% and lastly pigs with 2.4%. cattle, sheep and goats slaughtered in Rift-Valley Province had the highest prevalence of hydatidosis, which was 14.1%, 15.6% and 11.8% respectively. In pigs, the highest prevalence (0.8%) was recorded in central province. In all the species, hydatid cysts were found to be commonly located in the lungs and liver, and they were rarely encountered in the other organs. Prevalence of livestock hydatidosis in Kenya appears to have increased, thus concerted control measures should be undertaken with emphasis being placed on the provinces with the highest prevalence of the disease. The Kenya Veterinarian Vol. 27 2004: pp. 73-7

Prevalence of bovine mastitis and multi-antibiotic resistant Staphylococcus and Streptococcus species in a research centre farm at Naivasha, Kenya

A cross-sectional study was conducted on prevalence of mastitis, its bacterial causes, their antibiotic sensitivities and management practices of sahiwal and dairy cattle kept at a centre of Kenya Agricultural & Livestock Research Organization (KALRO) in Naivasha, Kenya. Clinical mastitis was diagnosed through physical examination of cows’ udders and milk. California Mastitis Test (CMT) was used to detect subclinical mastitis (SCM). Bacterial causes were determined by culture and their antibiotic sensitivities investigated by subjecting them to the commonly used antibiotics. Fifty cows were randomly selected from each herd giving a total of 100 cows. Prevalence of clinical mastitis in sahiwals at cow level was 6% (3/50) and subclinical mastitis (SCM) was 54% (27/50). Dairy herd had only SCM with a cow level prevalence of 36%. Prevalence of SCM was significantly different (p<0.05) between the herds. Sahiwal herd had 93.8% bacterial recovery rate with Staphylococcus species as the predominant bacteria (86.7%) (n=30). Other isolates included Streptococcus 6.3%, Corynebacterium 3.3%, and Escherichia coli. Mixed infection of Staphylococcus and Streptococcus was found in one case. Milk samples from dairy herd had a bacterial recovery rate of 85.7% with Staphylococcus species as the predominant (55.6%) bacteria. Other isolates included Streptococcus species (38.9%) and Corynebacterium (5.6%). Mixed infection consisting of Staphylococcus and Corynebacterium (5.6%) was also detected. Staphylococcus isolates had highest sensitivity to Gentamycin of 100% while Streptococci had the highest sensitivity for Ampicillin and Gentamycin of 100%, respectively. The isolates showed resistance to some commonly used antibiotics such as sulphamethoxazole, streptomycin and tetracycline. Bovine mastitis is prevalent among cows at KALRONaivasha and appropriate control methods needs to be applied to lower this prevalence. Further, this study has shown that Gentamycin and ampicillin are the drugs of choice for treating bovine mastitis in this institute. In fact, knowledge on prevalence of mastitis causing organisms and their antibiotic sensitivities will boost efficacy of therapy and cow productivity.Key words: antibiotic sensitivity, bacterial causes, dairy herd, mastitis prevalence, Sahiwal her

Core competencies in applied infectious disease epidemiology: a framework for countries in Europe

In 2009, the European Centre for Disease Prevention and Control (ECDC) developed a competency frame-work to support European Union countries and the European Commission in ensuring a competent public health workforce for Europe. The coronavirus disease (COVID-19) pandemic emphasised the importance of harmonised public health strategies and competen-cies across international boundaries, specifically for infectious diseases. This perspective presents the process to update the competency framework for applied infectious disease epidemiology, highlight-ing ECDC's efforts to support countries with using the framework. ECDC commissioned the Association of Schools of Public Health in the European Region (ASPHER) to update the framework through publica-tion and dissemination of a technical report and a self-assessment tool linked to training resources. A mixed methods approach to gather input from experts in rel-evant specialities included qualitative interviews with 42 experts, workshops with ECDC Technical Advisory Group and an online survey of 212 public health pro-fessionals across Europe and beyond. Modifications resulted in 157 core competencies in 23 domains, each mapping to one of six subject areas of importance in applied infectious disease epidemiology. The frame-work serves as a basis to update the curriculum of the ECDC Fellowship programme with two alternative paths: intervention epidemiology or public health microbiology

The Young Women's Health CoOp in Cape Town, South Africa: Study protocol for a cluster-randomised trial for adolescent women at risk for HIV

Background: South Africa remains the global epicentre of HIV infection, and adolescent women have the highest incidence of HIV in the country. South Africa also has high rates of alcohol and other drug (AOD) use, violence, and gender inequality. Violence converges with AOD use, gender inequities and other disparities, such as poverty, to increase sexual risk and poor educational attainment for adolescent women. This study seeks to test the efficacy of peer recruitment and cofacilitation of the Young Women's Health CoOp (YWHC), a comprehensive gender-focused intervention to reduce HIV risk behaviours and increase the uptake of HIV counselling and testing (HCT) among out-of-school, adolescent women who use AODs. The YWHC is facilitated by local research staff and supported by peers. Methods: This cluster-randomised trial is enrolling participants into two arms: a control arm that receives standard HCT, and an intervention arm that receives the YWHC. Participants are enrolled from 24 economically disadvantaged communities in Cape Town, South Africa. These geographically distinct communities serve as clusters that are the units of randomisation. This study uses adolescent peer role models and research field staff to recruit marginalised adolescent women. At baseline, participants complete a questionnaire and biological testing for HIV, recent AOD use, and pregnancy. The core intervention is delivered in the month following enrollment, with linkages to health services and educational programmes available to participants throughout the follow-up period. Follow-up interviews and biological testing are conducted at 6 and 12 months post enrollment. Discussion: The study findings will increase knowledge of the efficacy of a comprehensive HCT, gender-focused programme in reducing AOD use, victimisation, and sexual risk behaviour and increase uptake services for out-of-school, adolescent women who use AODs. The trial results could lead to wider implementation of the YWHC for vulnerable adolescent women, a key population often neglected in health services. Trial registration: Trial registration no: NCT02974998, November 29, 2016