Evaluation of a Brief Intervention to Improve the Nursing Care of Young Children in a High HIV and AIDS Setting

The HIV epidemic in South Africa is putting great strain on health services, including the inpatient care of young children. Caregivers and young children (107 pairs) and 17 nurses participated in an intervention to improve the care of young children in hospital in a high HIV and AIDS setting. The intervention addressed caregiver expectations about admission and treatment, responsive feeding, coping with infant pain and distress, assistance with medical procedures, and preparation for discharge and home care. Following a preparatory and piloting phase, measures of nurse burnout, caregiver physical and emotional well-being, and caregiver-child interaction were made before and after intervention. No changes were found between before and after intervention on assessments of caregiver wellbeing. However, mothers in the postintervention phase rated nurses as more supportive; mother-child interaction during feeding was more relaxed and engaged, and babies were less socially withdrawn. While the intervention proved useful in improving certain outcomes for children and their caregivers, it did not address challenging hospital and ward administration or support needed by caregivers at home following discharge. To address the latter need, the intervention has been extended into the community through home-based palliative care and support

The potential of decentralised wastewater treatment in urban and rural sanitation in South Africa: lessons learnt from a demonstration-scale DEWATS within the eThekwini Municipality

The design principles of decentralised wastewater treatment systems (DEWATS) make them a practical sanitation option for municipalities to adopt in fast-growing cities in South Africa. Since 2014, a demonstration scale DEWATS with a modular design consisting of a settler, anaerobic baffled reactor (ABR), anaerobic filter (AF), vertical down-flow constructed wetland (VFCW) and horizontal flow constructed wetland (HFCW) has been in operation in eThekwini. A performance evaluation after the long-term operation was undertaken in 2019 by comparing the final effluent with national regulatory requirements. Despite limitations in characterising the raw wastewater, a comparison of the settler and final effluent quality indicated high (≥ 85%) removal efficiencies of total chemical oxygen demand (CODt), ammonium-N (NH4-N) and orthophosphate-P (PO4-P), 75% removal of total suspended solids (TSS) and 83.3% log10 removal of Escherichia coli. Lack of exogenous and endogenous carbon and high dissolved oxygen (DO) concentrations (> 0.5 mg·L−1) inhibited denitrification in the HFCW, resulting in 12.5% of the effluent samples achieving compliance for nitrate-N (NO3-N). Moreover, mixed aggregate media and low residence times in the HFCW may have also contributed to poor NO3-N removal. During the COVID-19 lockdown, an unexpected shutdown and subsequent resumption of flow to the DEWATS indicated a 16-week recovery time based on achieving full nitrification in the HFCW. Although design modifications are necessary for the HFCW, the installation of urine diversion flushing toilets at the household level will reduce the nutrient loading to the DEWATS and potentially achieve fully compliant effluent. Alternatively, the application of two-stage vertical flow constructed wetlands to improve denitrification should also be explored in the South African context. With an improved design, DEWATS has the potential to fill the gap in both urban and rural sanitation in South Africa, where waterborne sanitation is still desired but connections to conventional wastewater treatment works (WWTWs) are not possible.&nbsp

Addressing social issues in a universal HIV test and treat intervention trial (ANRS 12249 TasP) in South Africa: methods for appraisal

Background: The Universal HIV Test and Treat (UTT) strategy represents a challenge for science, but is also a challenge for individuals and societies. Are repeated offers of provider-initiated HIV testing and immediate antiretroviral therapy (ART) socially-acceptable and can these become normalized over time? Can UTT be implemented without potentially adding to individual and community stigma, or threatening individual rights? What are the social, cultural and economic implications of UTT for households and communities? And can UTT be implemented within capacity constraints and other threats to the overall provision of HIV services? The answers to these research questions will be critical for routine implementation of UTT strategies. Methods/design: A social science research programme is nested within the ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomised trial in rural South Africa. The programme aims to inform understanding of the (i) social, economic and environmental factors affecting uptake of services at each step of the continuum of HIV prevention, treatment and care and (ii) the causal impacts of the TasP intervention package on social and economic factors at the individual, household, community and health system level. We describe a multidisciplinary, multi-level, mixed-method research protocol that includes individual, household, community and clinic surveys, and combines quantitative and qualitative methods. Discussion: The UTT strategy is changing the overall approach to HIV prevention, treatment and care, and substantial social consequences may be anticipated, such as changes in social representations of HIV transmission, prevention, HIV testing and ART use, as well as changes in individual perceptions and behaviours in terms of uptake and frequency of HIV testing and ART initiation at high CD4. Triangulation of social science studies within the ANRS 12249 TasP trial will provide comprehensive insights into the acceptability and feasibility of the TasP intervention package at individual, community, patient and health system level, to complement the trial's clinical and epidemiological outcomes. It will also increase understanding of the causal impacts of UTT on social and economic outcomes, which will be critical for the long-term sustainability and routine UTT implementation. Trial registration: Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974

Young people's experiences of sexual and reproductive health interventions in rural KwaZulu-Natal, South Africa

Despite efforts to address HIV-infection, adolescents and young peoples’ (AYP) engagement in interventions remain suboptimal. Guided by a risk protection framework we describe factors that support positive and negative experiences of HIV and SRH interventions among AYP in rural KwaZulu-Natal, South Africa, using data from: community mapping; repeat semi-structured individual interviews (n = 58 in 2017, n = 50 in 2018, n = 37 in 2019–2020); and group discussions (n = 13). AYP who had appropriate and accurate HIV-and SRH-related information were reported to use health-care services. Responsive health-care workers, good family and peer relationships were seen to be protective through building close connections and improving self-efficacy to access care. In contrast to cross-generational relationships with men, alcohol and drug use and early pregnancy were seen to put AYP at risk. Policies and interventions are needed that promote stable and supportive relationships with caregivers and peers, positive social norms and non-judgemental behaviour within clinical services

Editorial: Understandings and conceptualizations of hope and how it influences engagement with sexual and reproductive health (SRH) services among adolescents in LMICs

This is the final version. Available on open access from Frontiers Media via the DOI in this rrecordAfrica Health Research InstituteWellcome TrustNational Institute for Health and Care Research (NIHR)UKR

Implementing an engineering field testing platform for sustainable non-sewered sanitation prototypes

Researchers globally are developing sanitation solutions that make faecal waste safe, are affordable, do not require external power, water or sewer connections and that recover and reuse water, energy and nutrients. The Engineering Field Testing platform is a collaboration between the Pollution Research Group at the University of KwaZulu-Natal, eThekwini Water and Sanitation and a private company, Khanyisa Projects, which provides a supportive space to test early engineering concepts in a real world environment, while still under the control of technology developers. Local teams of engineers, scientists and social scientists support technology developers through site selection, community engagement, ethical approval, site preparation, installation and commissioning, sampling, testing and feedback and decommissioning. This ensures that locally relevant risks can be identified and mitigated. The concentration of prototypes being tested in a single location allows support resources and expertise to be pooled and increases collaboration to overcome common challenges

Home-based intervention to test and start (HITS) protocol : a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment

Abstract: To realize the full benefits of treatment as prevention in many hyperendemic African contexts, there is an urgent need to increase uptake of HIV testing and HIV treatment among men to reduce the rate of HIV transmission to (particularly young) women. This trial aims to evaluate the effect of two interventions - microincentives and a tablet-based male-targeted HIV decision support application - on increasing home-based HIV testing and linkage to HIV care among men with the ultimate aim of reducing HIV-related mortality in men and HIV incidence in young women..

Twelve-month outcomes of patients admitted to the acute general medical service at Groote Schuur Hospital

Objectives. Hospitalisation for medical illness has ongoing impact on individuals, healthcare services and society beyond discharge. This study’s objective was to determine the 12-month mortality and functional outcomes of patients admitted to the acute medical service at Groote Schuur Hospital (GSH). Methods. Follow-up, using the hospital records system and provincial death registry, together with telephonic interviews or home visits, was attempted for 465 medical inpatients admitted to GSH between 14 September and 16 November 2009. Functional outcomes were assessed using the Katz activities of daily living (ADL) score and Barthel index (BI). Outcome measures. The major study outcomes included: 12-month mortality (overall and unexpected), changes in functional status and pre- and post-admission employment rates. Results. Inpatient mortality was 11%. At 12-month follow-up, 35% (145/415) were deceased and 30% (125/415) could not be traced; 38% (55/145) of deaths were considered expected and unexpected mortality was associated with age >40 years (p=0.02) and an admission urea >7.0 mmol/l (p=0.004). Katz ADL deteriorated in 15% (21/143) of interviewed patients and was associated with age >50 years (p=0.005); 23% (33/143) had improved Katz ADL associated with admission human immunodeficiency virus (HIV) (p=0.01), tuberculosis (TB) infection (p=0.05) and sepsis (p=0.02). Employment rates declined from 41% (59/145) pre-admission to 18% (26/145) at 12 months (

Entrepreneurial knowledge and aspirations of dentistry students in South Africa

An investigation of the intentions and knowledge of entrepreneurship of final-year university dentistry students is reported, with particular regard to the factors of gender and race. A questionnaire survey was used with final-year dentistry students, over two years, at the University of the Western Cape in South Africa. The findings show that dentistry students across race and gender groups believed that entrepreneurship education was important. At least half of the students showed an interest in starting a business practice soon after their graduation and completion of a mandatory one-year internship, with more male students indicating an interest in starting a business than female students. More Black African students indicated interest compared to other race groups (Coloureds, Whites and Indians). There were no significant differences between male and female students with regard to knowledge of entrepreneurship, but there were significant differences with regard to race in the scores for knowledge of entrepreneurship, with White students scoring the highest and African students the lowest. The authors conclude that entrepreneurship education should be included in the curriculum in the final year of dentistry studies to encourage business practice start-up soon after the one-year internship period, with the aim of contributing to growth in employment.Department of HE and Training approved lis