Significance of HbA1c levels in diabetic retinopathy extremes in South Africa

Background. Diabetic retinopathy (DR) is one of the leading causes of blindness in sub-Saharan Africa and globally, placing a huge disease burden on patients and the public health system. DR varies in severity from non-proliferative to proliferative DR (PDR). Objectives. Using a monitor of medium-to long-term blood glucose control, to determine the association between glycated haemoglobin (HbA1c) levels in patients with PDR and those with no DR. Methods. A prospective, cross-sectional study was conducted at McCord Provincial Eye Hospital in Durban, South Africa. We studied only patients diagnosed with diabetes mellitus (DM) for >1 year who had either PDR or no DR, and compared their HbA1c levels. Patients with non-proliferative DR were not included. Results. Patients with PDR had significantly higher HbA1c levels than those with no DR. Patients with type 1 DM had higher HbA1c levels than patients with type 2 DM in both the PDR and no-DR groups. Older patients (>70 years) had lower HbA1c levels than younger patients. Gender, race and duration of diabetes had no influence on HbA1c levels. Conclusions. PDR was associated with higher HbA1c in type 2 DM in all races and age groups and was independent of duration of disease. The trend was the same for type 1 DM, but significance could not be reached, probably because of small numbers in this subset of patients

Significance of HbA1c levels in diabetic retinopathy extremes in South Africa

Background. Diabetic retinopathy (DR) is one of the leading causes of blindness in sub-Saharan Africa and globally, placing a huge disease burden on patients and the public health system. DR varies in severity from non-proliferative to proliferative DR (PDR).Objectives. Using a monitor of medium- to long-term blood glucose control, to determine the association between glycated haemoglobin (HbA1c) levels in patients with PDR and those with no DR.Methods. A prospective, cross-sectional study was conducted at McCord Provincial Eye Hospital in Durban, South Africa. We studied only patients diagnosed with diabetes mellitus (DM) for >1 year who had either PDR or no DR, and compared their HbA1c levels. Patients with non-proliferative DR were not included.Results. Patients with PDR had significantly higher HbA1c levels than those with no DR. Patients with type 1 DM had higher HbA1c levels than patients with type 2 DM in both the PDR and no-DR groups. Older patients (>70 years) had lower HbA1c levels than younger patients. Gender, race and duration of diabetes had no influence on HbA1c levels.Conclusions. PDR was associated with higher HbA1c in type 2 DM in all races and age groups and was independent of duration of disease. The trend was the same for type 1 DM, but significance could not be reached, probably because of small numbers in this subset of patients

Evaluation of land suitability methods with reference to neglected and underutilised crop species: A scoping review

In agriculture, land use and land classification address questions such as “where”, “why” and “when” a particular crop is grown within a particular agroecology. To date, there are several land suitability analysis (LSA) methods, but there is no consensus on the best method for crop suitability analysis. We conducted a scoping review to evaluate methodological strategies for LSA. Secondary to this, we assessed which of these would be suitable for neglected and underutilised crop species (NUS). The review classified LSA methods reported in articles as traditional (26.6%) and modern (63.4%). Modern approaches, including multi-criteria decision-making (MCDM) methods such as analytical hierarchy process (AHP) (14.9%) and fuzzy methods (12.9%); crop simulation models (9.9%) and machine learning related methods (25.7%) are gaining popularity over traditional methods. The MCDM methods, namely AHP and fuzzy, are commonly applied to LSA while crop models and machine learning related methods are gaining popularity. A total of 67 parameters from climatic, hydrology, soil, socio-economic and landscape properties are essential in LSA. Unavailability and the inclusion of categorical datasets from social sources is a challenge

Multi-criteria suitability analysis for neglected and underutilised crop species in South Africa

Several neglected and underutilised species (NUS) provide solutions to climate change and creating a Zero Hunger world, the Sustainable Development Goal 2. Several NUS are drought and heat stress-tolerant, making them ideal for improving marginalised cropping systems in drought-prone areas. However, owing to their status as NUS, current crop suitability maps do not include them as part of the crop choices. This study aimed to develop land suitability maps for selected NUS [sorghum, (Sorghum bicolor), cowpea (Vigna unguiculata), amaranth and taro (Colocasia esculenta)] using Analytic Hierarchy Process (AHP) in ArcGIS. Multidisciplinary factors from climatic, soil and landscape, socio-economic and technical indicators overlaid using Weighted Overlay Analysis. Validation was done through field visits, and area under the curve (AUC) was used to measure AHP model performance. The results indicated that sorghum was highly suitable (S1) = 2%, moderately suitable (S2) = 61%, marginally suitable (S3) = 33%, and unsuitable (N1) = 4%, cowpea S1 = 3%, S2 = 56%, S3 = 39%, N1 = 2%, amaranth S1 = 8%, S2 = 81%, S3 = 11%, and taro S1 = 0.4%, S2 = 28%, S3 = 64%, N1 = 7%, of calculated arable land of SA (12 655 859 ha). Overall, the validation showed that the mapping exercises exhibited a high degree of accuracies (i.e. sorghum AUC = 0.87, cowpea AUC = 0.88, amaranth AUC = 0.95 and taro AUC = 0.82). Rainfall was the most critical variable and criteria with the highest impact on land suitability of the NUS. Results of this study suggest that South Africa has a huge potential for NUS production. The maps developed can contribute to evidence-based and site-specific recommendations for NUS and their mainstreaming. Also, the maps can be used to design appropriate production guidelines and to support existing policy frameworks which advocate for sustainable intensification of marginalised cropping systems through increased crop diversity and the use of stress-tolerant food crops

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

Sustainable intensification of agriculture for human prosperity and global sustainability

There is an ongoing debate on what constitutes sustainable intensification of agriculture (SIA). In this paper, we propose that a paradigm for sustainable intensification can be defined and translated into an operational framework for agricultural development. We argue that this paradigm must now be defined—at all scales—in the context of rapidly rising global environmental changes in the Anthropocene, while focusing on eradicating poverty and hunger and contributing to human wellbeing. The criteria and approach we propose, for a paradigm shift towards sustainable intensification of agriculture, integrates the dual and interdependent goals of using sustainable practices to meet rising human needs while contributing to resilience and sustainability of landscapes, the biosphere, and the Earth system. Both of these, in turn, are required to sustain the future viability of agriculture. This paradigm shift aims at repositioning world agriculture from its current role as the world’s single largest driver of global environmental change, to becoming a key contributor of a global transition to a sustainable world within a safe operating space on Earth

Observed controls on resilience of groundwater to climate variability in sub-Saharan Africa

Groundwater in sub-Saharan Africa supports livelihoods and poverty alleviation, maintains vital ecosystems, and strongly influences terrestrial water and energy budgets. Yet the hydrological processes that govern groundwater recharge and sustainability—and their sensitivity to climatic variability—are poorly constrained. Given the absence of firm observational constraints, it remains to be seen whether model-based projections of decreased water resources in dry parts of the region are justified. Here we show, through analysis of multidecadal groundwater hydrographs across sub-Saharan Africa, that levels of aridity dictate the predominant recharge processes, whereas local hydrogeology influences the type and sensitivity of precipitation–recharge relationships. Recharge in some humid locations varies by as little as five per cent (by coefficient of variation) across a wide range of annual precipitation values. Other regions, by contrast, show roughly linear precipitation–recharge relationships, with precipitation thresholds (of roughly ten millimetres or less per day) governing the initiation of recharge. These thresholds tend to rise as aridity increases, and recharge in drylands is more episodic and increasingly dominated by focused recharge through losses from ephemeral overland flows. Extreme annual recharge is commonly associated with intense rainfall and flooding events, themselves often driven by large-scale climate controls. Intense precipitation, even during years of lower overall precipitation, produces some of the largest years of recharge in some dry subtropical locations. Our results therefore challenge the ‘high certainty’ consensus regarding decreasing water resources in such regions of sub-Saharan Africa. The potential resilience of groundwater to climate variability in many areas that is revealed by these precipitation–recharge relationships is essential for informing reliable predictions of climate-change impacts and adaptation strategies

Irrigating Africa: policy barriers and opportunities for enhanced productivity of smallholder farmers

African governments have ambitious plans to expand irrigated agriculture, though existing smallholder schemes have largely failed to use land and water sustainably or become profitable. Six government-owned irrigation schemes in Mozambique, Tanzania and Zimbabwe were assessed to identify common policy barriers and opportunities for higher productivity among smallholder farmers. Issues like insecure land tenure systems, unclear institutional arrangements and poor access to markets have contributed to limited profitability. Reform of currently insecure land tenure, strengthening farmer organizations and reforming policies are recommended so that governments step back from scheme management and foster market linkages to enable more profitable irrigated agriculture