The prevalence of alcohol use disorders at Luthando neuropsychiatric HIV clinic

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Psychiatry. Johannesburg, 2016Background: The prevalence of Alcohol Use Disorders (AUD) is high in people with Severe Mental Illness (SMI) and in people infected with the Human Immunodeficiency Virus (HIV). The aim of the study was to determine the prevalence of alcohol use disorders in patients with comorbid HIV and SMI attending Luthando Neuropsychiatric HIV clinic at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods: A retrospective record review was conducted to estimate the prevalence of alcohol use disorders (AUD). The Alcohol Use Disorders Identification Test – self report (AUDIT) was used to estimate the prevalence of AUD. Descriptive analysis was used for categorical data. The χ2 and the Fisher exact tests were employed to evaluate the relationship between the demographic and clinical variables. The strength of the associations was measured by Cramer’s V and the phi coefficient respectively. Results: A convenient sample of 111 patients participated in the study. The prevalence of AUD was 13.5% (95% CI 7.1 – 19.9%). Of the total participants, 28.8% (95% CI 20.4 – 37.2%) consumed alcohol at a hazardous level, 18.9% (95% CI 11.6 – 26.2%) had incipient alcohol dependence and 20.7% (95% CI 13.2 – 28.2%) had alcohol related harm. There was a significant association between employment status and the categorized AUDIT scores. There was a significant association between viral load suppression and each of the categorized AUDIT scores. There was a significant, association between history of substance abuse and each of the categorized AUDIT scores. Conclusion: The prevalence of AUD is high among patients attending Luthando Neuropsychiatric HIV clinic. Patients with SMI and HIV should be screened for AUD and the pattern of alcohol consumption should also be assessed as it can negatively affect clinical outcomes.MT201

Challenges Faced by Teachers in the Implementation of Guidance and Counselling in Eswatini Primary Schools

Providing guidance and counselling in schools is one of the most important services a school has to have and it is the reason why the Ministry of Education and Training (MoET) introduced guidance and counselling in both primary and high schools of Eswatini. However, there are obstacles that affect the effective implementation of guidance and counselling in schools. Thus, there was a need to find out the challenges teachers face in the implementation of guidance and counselling in Eswatini primary schools. The study was a qualitative study and it employed a multiple case study design. There were 27 participants from the Shiselweni guidance and counselling pilot schools who were selected purposively. Data were collected through focus group discussions and in-depth interviews. A thematic analysis was used to analyse the data. The main findings of the study revealed that guidance and counselling is affected by role ambiguity for guidance and counselling teachers, lack of required resources and inadequate supervision. Therefore, there is a great need for the Ministry of Education and Training to develop clear policies for running and managing guidance and counselling services in schools. Keywords: challenges, guidance and counselling, implementation, Primary school, Shiselweni, DOI: 10.7176/JEP/10-12-21 Publication date: April 30th 201

A comparison of Normalised Difference Snow Index (NDSI) and Normalised Difference Principal Component Snow Index (NDPCSI) techniques in distinguishing snow from related land cover types

Snow is a common global meteorological phenomenon known to be a critical component of the hydrological cycle and an environmental hazard. In South Africa, snow is commonly limited to the country’s higher grounds and is considered one of the most destructive natural hazards. As a result, mapping of snow cover is an important process in catchment management and hazard mitigation. However, generating snow maps using survey techniques is often expensive, tedious and time consuming. Within the South African context, field surveys are therefore not ideal for the often highly dynamic snow covers. As an alternative, thematic cover–types based on remotely sensed data-sets are becoming popular. In this study we hypothesise that the reduced dimensionality using Principal Components Analysis (PCA) in concert Normalized Difference Snow Index (NDSI) is valuable for improving the accuracy of snow cover maps. Using the recently launched 11 spectral band Landsat 8 dataset, we propose a new technique that combines the principal component imager generated using PCA with commonly used NDSI, referred to as Normalised Difference Principal Component Snow Index (NDPCSI) to improve snow mapping accuracy. Results show that both NDPCSI and NDSI with high classification accuracies of 84.9% and 76.8% respectively, were effective in mapping snow. Results from the study also indicate that NDSI was sensitive to water bodies found on lower grounds within the study area while the PCA was able to de-correlate snow from water bodies and shadows. Although the NDSI and NDPCSI produced comparable results, the NDPCSI was capable of mapping snow from other related land covers with better accuracy. The superiority of the NDPCSI can particularly be attributed to the ability of principal component analysis to de-correlate snow from water bodies and shadows. The accuracy of both techniques was evaluated using a higher spatial resolution Landsat 8 panchromatic band and Moderate Resolution Imaging Spectroradiometer (MODIS) data acquired on the same day. The findings suggest that NDPCSI is a viable alternative in mapping snow especially in heterogeneous landscape that includes water bodies

Some Swazi phytomedicines and their constituents

Ethnobotanical surveys of Manzini and Shiselweni regions of Swaziland were conducted to document new phytomedicines used in Swaziland and to determine their chemical constituents with a view toprovide the scientific basis of the use of the remedies in traditional medical practice and as a guide to bioprospecting for drugs. The plants collected in the surveys were extracted with suitable solvents andanalysed for secondary metabolites. Sixty one medicinal plants from thirty five families used for treating thirty one diseases were analysed. The medicinal uses of these plants had never been documentedin the pharmacopoeia of Swaziland. Different classes of secondary metabolites were found in the plants, namely alkaloids, anthranoids, flavonoids, glycosides, polyphenols, saponins, steroids andtannins. Some of the diseases the plants were used to treat are back ache, cardiac problems, chest pain, cough, diabetes, diarrhoea, headache, menorrhagia, snake bite, stomach ache and urino-genitalproblems. The presence of these secondary metabolites in the plants was of great importance in the understanding of the basis of the use of the plants in traditional medical practice and may provide alead in bioprospecting for new pharmaceutical products of herbal origin

Scalar perturbations of Schwarzschild black holes in modified gravity.

Doctor of Philosophy in Applied Mathematics, University of KwaZulu-Natal, Westville, 2017.This thesis is concerned with the physics related to scalar perturbations in the Schwarzschild geometry that arise in modifed gravity theories. It has already been shown that the gravitational waves emitted from a Schwarzschild black hole in f(R) gravity have no signatures on the modification of gravity from General Relativity, as the Regge-Wheeler equation remains invariant. In this thesis we consider the perturbations of the Ricci scalar in a vacuum Schwarzschild spacetime, which is unique to higher order theories of gravity and is absent in General Relativity. We show that the equations that govern these perturbations can be reduced to a Volterra integral equation. We explicitly calculate the reflection coefficients for the Ricci scalar perturbations, when they are scattered by the black hole potential barrier. Our analysis shows that a larger fraction of these Ricci scalar waves are reflected compared to the gravitational waves. This may provide a novel observational signature for fourth order gravity. We also show that higher order curvature corrections to General Relativity, in the strong gravity regime on scales of the order of the near horizon, produce a rapidly oscillating and infalling Ricci scalar fireball just outside the horizon. These fluctuations behave like an infalling extra massive scalar field that can generate the ringdown modes of gravitational waves having the same natural frequency as those that are generated by black hole mergers. Our analysis provides a viable classical or semi-classical explanation for the echoes in the ringdown modes without invoking the existence of any exotic structures at the horizon

Constituents of Two Dioscorea Species That Potentiate Antibiotic Activity against MRSA

The isolation of two diarylnonanoids from Dioscorea cotinifolia possessing antibiotic-potentiating activity against resistant strains of S. aureus are reported. The diarylnonanoids are a class of natural products similar in structure to the diarylheptanoids, which have a wide spectrum of reported biological activities. One of the diarylnonanoids (1) isolated possesses a chiral center, and to deduce its configuration, the modified Mosher ester method was used. Using both 1D and 2D NMR data, as many protons as possible were assigned to both the R- and S-MTPA esters, and the configuration of the chiral center in 1 was determined to be R. Both the chiral and achiral diarylnonanoid (2) exhibited potent antibiotic-potentiating activity with the chiral natural product showing a greater tetracycline-potentiating activity than 2. Interestingly, 2 gave a higher norfloxacin-potentiating activity with a resultant higher efflux pump inhibitory activity. Manipulation of the structure of the diarylnonanoids through synthesis could lead to improved biological activity

Methods to promote equity in health resource allocation in low- and middle-income countries : an overview

Unfair differences in healthcare access, utilisation, quality or health outcomes exist between and within countries around the world. Improving health equity is a stated objective for many governments and international organizations. We provide an overview of the major tools that have been developed to measure, evaluate and promote health equity, along with the data required to operationalise them. Methods are organised into four key policy questions facing decision-makers: (i) what is the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity. Benefit incidence analysis can be used to estimate the distribution of current public health sector expenditure, with geographical resource allocation formulae and health system reform being the main government policy levers for improving equity. Techniques from the economic evaluation literature, such as extended and distributional cost-effectiveness analysis can be used to identify ‘best buy’ interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity. Methods from the economics literature can provide policymakers with a toolkit for addressing multiple aspects of health equity, from outcomes to financial protection, and can be adapted to accommodate data commonly available in low- and middle-income settings

Is universal coverage via social health insurance financially feasible in Swaziland?

Objective. The Government of Swaziland decided to explore the feasibility of social health insurance (SHI) in order to enhance universal access to health services. We assess the financial feasibility of a possible SHI scheme in Swaziland. The SHI scenario presented is one that mobilises resources additional to the maintained Ministry of Health and Social Welfare (MOHSW) budget. It is designed to increase prepayment, enhance overall health financing equity, finance quality improvements in health care, and eventually cover the entire population. Methods. The financial feasibility assessment consists of calculating and projecting revenues and expenditures of the SHI scheme from 2008 to 2018. SimIns, a health insurance simulation software, was used. Quantitative data from government and other sources and qualitative data from discussions with health financing stakeholders were gathered. Policy assumptions were jointly developed with and agreed upon by a MOHSW team. Results and conclusion. SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based on a mix of contributory and tax financing. Contribution rates for formal sector employees would amount to 7% of salaries and the Ministry of Health and Social Welfare budget would need to be maintained. Government health expenditure including social health insurance would increase from 6% in 2008 to 11% in 2018

Incorporating concerns for equity into health resource allocation : A guide for practitioners

Introduction Unfair differences in health care access, quality or health outcomes exist between and within countries around the world, and improving health equity is an important social objective for many governments and international organizations. This paper summaries the methods for analysing health equity available to policymakers regarding the allocation of health sector resources. Methods We provide an overview of the major tools that have been developed to measure, evaluate and promote health equity, along with the data required to operationalise them. These are organised into four key policy questions facing decision-makers: (i) what is the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity. Analysis Benefit incidence analysis is identified as the principal tool for estimating the distribution of current public health sector expenditure, with geographical resource allocation formulae and health system reform being the main government policy levers for improving equity. Techniques from the economic evaluation literature, such as extended and distributional cost-effectiveness analysis can be used to identify ‘best buy’ interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity. Discussion Methods from the economics literature can be used to generate novel evidence on the health equity impacts of resource allocation decisions. They provide policymakers with a toolkit for addressing multiple aspects of health equity, from health outcomes to financial protection, and can be adapted to accommodate data commonly available in either high income or low and middle income settings. However, the quality and reliability of the data are crucial to the validity of all methods

Effects of Kraal Manure ApplicationRates on Growth and Yield of Wild Okra (Corchorus olitorius L) in a Sub-tropical Environment

Abstract: Wild okra (Corchorus olitorius L) is an important indigenous vegetable in Swaziland. Although the crop is a popular vegetable among rural communities, not much has been done to produce organic fertilizer application recommendations for its production. The purpose of this research was to investigate the effects of kraal manure application rates on growth and yield of wild okra. Kraal manure was applied at varying rates of 20, 40 and 60 tons/ha in a Randomized Complete Block Design (RCBD) where 2.3.2 (22) an inorganic fertilizer was used as a control, and was applied at the rate of 150 kg/ha. For every increase in the application level of kraal manure there were significant (p<0.05) increases in all the growth parameters that were measured. There were also significant (p<0.05) differences of fresh mass and dry mass yield of wild okra. There was an increase in fresh and dry mass yield with every increase in application level of kraal manure while the least fresh and dry mass was recorded in plants provided with 2.3.2 (22). Kraal manure applied at 60 ton/ha gave the highest yield of wild okra under the conditions of this experiment