Investigating the feasibility of the use of Moladi construction technology to assist in-situ upgrading in informal settlements within the eThekwini Metropolitan area.

Master of Housing. University of KwaZulu-Natal, Durban 2017.The existing South African housing backlog confronting the residents is daunting. With the current investigations displaying that the backlog is not depleting or not reaching levels anticipated by the democratic government, the stakeholders of low-income housing sector are facing an immense challenge. Most houses constructed after 1994 utilised conventional brick and mortar construction, with alternative construction methods of housing only taking up an insignificant portion in the total housing supply. The purpose of this study is to investigate the feasibility of Moladi construction technology as a valid alternative to the traditional low-cost housing model, in terms of delivery time, quality and total cost. Social acceptance is also analysed as a parameter that affects the success of Moladi construction model. This parameter represents the basis that indicates the feasibility of a new method implementation. Hence, the study dealt with the potential impacts of implementing an alternative construction technology for in-situ upgrading projects, and in particular for the case study of Piesang River and Namibia Stop 8 settlements in Inanda, under the eThekwini Municipality jurisdiction. The main purpose of this study is to assess the level of willingness of low-income residents to use alternative construction technologies instead of the conventional ones, with the aim of reducing time and cost delivery, while not compromising the overall quality. Moreover, this research seeks to estimate the role of community participation in planning and implementation phases of housing projects. The study applied a comparative research design by means of case studies and is based on qualitative research methods. The findings indicate that the use of alternative construction can be considered a satisfactory solution to low-income groups, more so in the informal settlements due to cost, speed of construction and quality production. Thus, the proposed recommendations suggest that the city administration should be given more attention to the use of less costly alternative materials and technologies without affecting the quality of construction. Finally, the government policy intervention, in conformity with the introduction of new construction technology that could be managed by the beneficiaries themselves, should get serious attention. Allowing for a sense of ownership for these housing projects from the beneficiaries. The findings of the research point out that using Moladi as an option to assist or replace the conventional brick and mortar built housing will be feasible due its ability to reduce cost, time while not compromising quality

Successful MDR-TB Treatment Regimens Including Amikacin are Associated with High Rates of Hearing Loss

Aminoglycosides are a critical component of multidrug-resistant tuberculosis (MDR-TB) treatment but data on their efficacy and adverse effects in Botswana is scarce. We determined the effect of amikacin on treatment outcomes and development of hearing loss in MDR-TB patients. Patients started on MDR-TB treatment between 2006 and 2012 were included. Multivariate analysis was used to determine the effect of amikacin on treatment outcomes and development of hearing loss

Tuberculosis and Silicosis Burden in Artisanal and Small-Scale Gold Miners in a Large Occupational Health Outreach Programme in Zimbabwe.

Artisanal and small-scale miners (ASMs) labour under archaic working conditions and are exposed to high levels of silica dust. Exposure to silica dust has been associated with an increased risk of tuberculosis and silicosis. ASMs are highly mobile and operate in remote areas with near absent access to health services. The main purpose of this study was to evaluate the prevalence of tuberculosis, silicosis and silico-tuberculosis among ASMs in Zimbabwe. A cross-sectional study was conducted from 1 October to 31 January 2021 on a convenient sample of 514 self-selected ASMs. We report the results from among those ASMs who attended an outreach medical facility and an occupational health clinic. Data were collected from clinical records using a precoded data proforma. Data variables included demographic (age, sex), clinical details (HIV status, GeneXpert results, outcomes of chest radiographs, history of tuberculosis) and perceived exposure to mine dust. Of the 464 miners screened for silicosis, 52 (11.2%) were diagnosed with silicosis, while 17 (4.0%) of 422 ASMs were diagnosed with tuberculosis (TB). Of the 373 ASMs tested for HIV, 90 (23.5%) were sero-positive. An HIV infection was associated with a diagnosis of silicosis. There is need for a comprehensive occupational health service package, including TB and silicosis surveillance, for ASMs in Zimbabwe. These are preliminary and limited findings, needing confirmation by more comprehensive studies

The Triple Burden of Tuberculosis, Human Immunodeficiency Virus and Silicosis among Artisanal and Small-Scale Miners in Zimbabwe

Artisanal and small-scale mining is characterized by an excessive exposure to silica-containing dust, overcrowding, poor living conditions and limited access to primary health services. This poses a risk to tuberculosis, HIV infection and silicosis. The main purpose of the study is to evaluate the burden of tuberculosis, HIV and silicosis among artisanal and small-scale miners. We conducted a cross sectional study on 3821 artisanal and small-scale miners. We found a high burden of silicosis (19%), tuberculosis (6.8%) and HIV (18%) in a relatively young population, with the mean age of 35.5 years. Men were 1.8 times more likely to be diagnosed with silicosis compared to women, adjusted prevalence ratio [aPR = 1.75 (95% CI: 1.02-2.74)]. Artisanal and small-scale miners who were living with HIV were 1.25 times more likely to be diagnosed with silicosis compared to those who were negative, [aPR = 1.25 (1.00-1.57)]. The risk of silicosis increased with both duration as a miner and severity of exposure to silica dust. The risk of tuberculosis increased with the duration as a miner. Zimbabwe is currently experiencing a high burden of TB, silicosis and HIV among artisanal and small-scale miners. Multi-sectoral and innovative interventions are required to stem this triple epidemic in Zimbabwe

Declining Trends in Childhood TB Notifications and Profile of Notified Patients in the City of Harare, Zimbabwe, from 2009 to 2018.

Globally, childhood tuberculosis (TB among those aged <15 years) is a neglected component of national TB programmes in high TB burden countries. Zimbabwe, a country in southern Africa, is a high burden country for TB, TB-HIV, and drug-resistant TB. In this study, we assessed trends in annual childhood TB notifications in Harare (the capital of Zimbabwe) from 2009 to 2018 and the demographic, clinical profiles, and treatment outcomes of childhood TB patients notified from 2015-2017 by reviewing the national TB programme records and reports. Overall, there was a decline in the total number of TB patients (all ages) from 5,943 in 2009 to 2,831 in 2018. However, the number of childhood TB patients had declined exponentially 6-fold from 583 patients (117 per 100,000 children) in 2009 to 107 patients (18 per 100,000 children) in 2018. Of the 615 childhood TB patients notified between 2015 and 2017, 556 (89%) patient records were available. There were 53% males, 61% were aged <5 years, 92% were new TB patients, 85% had pulmonary TB, and 89% were treated for-drug sensitive TB, 3% for drug-resistant TB, and 40% were HIV positive (of whom 59% were on ART). Although 58% had successful treatment outcomes, the treatment outcomes of 40% were unknown (not recorded or not evaluated), indicating severe gaps in TB care. The disproportionate decline in childhood TB notifications could be due to the reduction in the TB burden among HIV positive individuals from the scale up of antiretroviral therapy and isoniazid preventive therapy. However, the country is experiencing economic challenges which could also contribute to the disproportionate decline in childhood TB notification and gaps in quality of care. There is an urgent need to understand the reasons for the declining trends and the gaps in care

Longer hospital stay is associated with higher rates of tuberculosis-related morbidity and mortality within 12 months after discharge in a referral hospital in Sub-Saharan Africa

BACKGROUND: Nosocomial transmission of pulmonary tuberculosis (PTB) is a problem in resource-limited settings. However, the degree of TB exposure and the intermediate- and long-term morbidity and mortality of hospital-associated TB is unclear. In this study we determined: 1) the nature, patterns and intensity of TB exposure occurring in the context of current TB cohorting practices in medical centre with a high prevalence of TB and HIV; 2) the one-year TB incidence after discharge; and 3) one-year TB-related mortality after hospital discharge. METHODS: Factors leading to nosocomial TB exposure were collected daily over a 3-month period. Patients were followed for 1-year after discharge. TB incidence and mortality were calculated and logistic regression was used to determine the factors associated with TB incidence and mortality during follow up. RESULTS: 1,094 patients were admitted to the medical wards between May 01 and July 31, 2010. HIV was confirmed in 690/1,094 (63.1%) of them. A total of 215/1,094 (19.7%) patients were diagnosed with PTB and 178/1,094 (16.3%) patients died during the course of their hospitalization; 12/178 (6.7%) patients died from TB-related complications. Eventually, 916 (83.7%) patients were discharged and followed for one year after it. Of these, 51 (5.6%) were diagnosed with PTB during the year of follow up (annual TB rate of 3,712 cases per 100,000 person per year). Overall, 57/916 (6.2%) patients died during the follow up period, of whom 26/57 (45.6%) died from confirmed TB. One-year TB incidence rate and TB-associated mortality were associated with the number of days that the patient remained hospitalized, the number of days spent in the cohorting bay (regardless of whether the patient was eventually diagnosed with TB or not), and the number and proximity to TB index cases. There was no difference in the performance of each of these 3 measurements of nosocomial TB exposure for the prediction of one-year TB incidence. CONCLUSION: Substantial TB exposure, particularly among HIV-infected patients, occurs in nosocomial settings despite implementation of cohorting measures. Nosocomial TB exposure is strongly associated with one-year TB incidence and TB-related mortality. Further studies are needed to identify strategies to reduce such exposure among susceptible patients

Oral abstracts of the 21st International AIDS Conference 18-22 July 2016, Durban, South Africa

The rate at which HIV-1 infected individuals progress to AIDS is highly variable and impacted by T cell immunity. CD8 T cell inhibitory molecules are up-regulated in HIV-1 infection and associate with immune dysfunction. We evaluated participants (n=122) recruited to the SPARTAC randomised clinical trial to determine whether CD8 T cell exhaustion markers PD-1, Lag-3 and Tim-3 were associated with immune activation and disease progression.Expression of PD-1, Tim-3, Lag-3 and CD38 on CD8 T cells from the closest pre-therapy time-point to seroconversion was measured by flow cytometry, and correlated with surrogate markers of HIV-1 disease (HIV-1 plasma viral load (pVL) and CD4 T cell count) and the trial endpoint (time to CD4 count <350 cells/μl or initiation of antiretroviral therapy). To explore the functional significance of these markers, co-expression of Eomes, T-bet and CD39 was assessed.Expression of PD-1 on CD8 and CD38 CD8 T cells correlated with pVL and CD4 count at baseline, and predicted time to the trial endpoint. Lag-3 expression was associated with pVL but not CD4 count. For all exhaustion markers, expression of CD38 on CD8 T cells increased the strength of associations. In Cox models, progression to the trial endpoint was most marked for PD-1/CD38 co-expressing cells, with evidence for a stronger effect within 12 weeks from confirmed diagnosis of PHI. The effect of PD-1 and Lag-3 expression on CD8 T cells retained statistical significance in Cox proportional hazards models including antiretroviral therapy and CD4 count, but not pVL as co-variants.Expression of ‘exhaustion’ or ‘immune checkpoint’ markers in early HIV-1 infection is associated with clinical progression and is impacted by immune activation and the duration of infection. New markers to identify exhausted T cells and novel interventions to reverse exhaustion may inform the development of novel immunotherapeutic approaches

Apports et limites de l’analyse de la performance financière par les ratios Cas : SPA Laiterie de DBK

114 p.:ill;30cm.(+cd)Parmi une multitude d'outils disponibles pour mesurer la performance financière, les ratios financiers sont les plus anciens et les plus utilisés. L'objectif de ce travail est d'essayer de comprendre les apports et les limites, ainsi que la suffisance, des ratios comme outil d'analyse de la performance financière. Pour atteindre cet objectif, nous élaborons d'abord le concept de performance et présentons en détail les différents outils ( y compris les ratios) utilisés pour analyser les états financiers. Pour cette partie de notre recherche, nous utilisons des livres, documents et sites dédiés à la finance d'entreprise et à l'analyse de la performance financière. Suite à une analyse des états financiers de l'entreprise « SPA Laiterie de DBK » en utilisant uniquement des ratios, nous abordons enfin les apports et les limites liés à l'utilisation des ratios comme outil d'analyse de la performance financière. Cette recherche sur le terrain permet de conclure que les ratios sont un outil indispensable pour déterminer les forces et les faiblesses d'une entreprise ; cependant, ils ne fournissent pas des solutions à ces faiblesses ; ainsi, il ne faut pas utiliser les ratios isolément