Quality assessment and primary uses of harvested rainwater in Kleinmond, South Africa

water security, reaching the Millennium Development Goals (MDGs) and sustaining water resources. The microbial and chemical quality of RWH samples collected from tanks in a sustainable housing development in Kleinmond, South Africa, were monitored. Results indicated that the tank water quality was within all the chemical standards (cations and anions) analysed for potable water. However, the counts of the indicator organisms, for example, total coliforms and Escherichia coli, exceeded the guidelines stipulated by the Department of Water Affairs and Forestry (1996). The microbial analysis results thus indicate that the tank water was not fit for potable use without treatment. A social research project was then conducted to describe, amongst others, the condition of the tank and the users’ knowledge of the RWH system. In addition, demographic data, viz., gender, household size and employment status, etc., were gathered in order to provide a socio-economic background description of the study population. Data were gathered by means of face-to-face interviews with 68 respondents. Generally, RWH was used for washing clothes and for cleaning inside and outside the houses. This study noted that without acceptance and necessary training to maintain and use the tank optimally, it is possible that social development projects, such as the one in Kleinmond, will not be sustainable.Keywords: domestic rainwater harvesting; microbial and chemical quality; social perception; acceptanc

Epidemiological patterns of hepatitis B virus (HBV) in highly endemic areas

This paper uses meta-analysis of published data and a deterministic mathematical model of hepatitis B virus (HBV) transmission to describe the patterns of HBV infection in high endemicity areas. We describe the association between the prevalence of carriers and a simple measure of the rate of infection, the age at which half the population have been infected (A50), and assess the contribution of horizontal and perinatal transmission to this association. We found that the two main hyper-endemic areas of sub-Saharan Africa and east Asia have similar prevalences of carriers and values of A50, and that there is a negative nonlinear relationship between A50 and the prevalence of carriers in high endemicity areas (Spearman's Rank, P = 0·0086). We quantified the risk of perinatal transmission and the age-dependent rate of infection to allow a comparison between the main hyper-endemic areas. East Asia was found to have higher prevalences of HBeAg positive mothers and a greater risk of perinatal transmission from HBeAg positive mothers than sub-Saharan Africa, though the differences were not statistically significant. However, the two areas have similar magnitudes and age-dependent rates of horizontal transmission. Results of a simple compartmental model suggest that similar rates of horizontal transmission are sufficient to generate the similar patterns between A50 and the prevalences of carriers. Interrupting horizontal transmission by mass immunization is expected to have a significant, nonlinear impact on the rate of acquisition of new carriers

Opportunities to improve sustainability on commercial pasture-based dairy farms by assessing environmental impact

For pasture-based dairy farming to become more sustainable, the negative environmental impacts associated with milk production must be minimized. These negative impacts include eutrophication, ammonia emissions and greenhouse gas (GHG) emissions. Two tools, a nutrient budget and a carbon footprint calculator, allow farm-level assessments of these negative impacts. In this study, a nutrient budget was used to calculate the efficiency of nitrogen and phosphorous use, and a carbon footprint calculator was used to calculate GHG emissions. Farm system descriptors were used to identify the farm systems that had the lowest environmental impact. Soil carbon was measured as an indicator of soil health, and the link between soil health, nutrient use efficiency and GHG emissions was examined. Nitrogen and phosphorous were not efficiently utilized on the farms included in this study, with a large excess of nutrients imported onto the farms each year. The average use efficiency was 29% for nitrogen, and 36% for phosphorous. The GHG emissions per liter of milk production were higher on the farms included in this study than found in previous studies on dairy farms, with an average of 1.39 kg of carbon dioxide equivalents emitted per kilogram of energy-corrected milk. Farm systems which optimized milk production on the available land, while applying the least amount of fertilizer and feeding the least amount of purchased feeds per milk produced, had the lowest environmental impact. Farms with higher soil carbon levels had higher nitrogen use efficiencies and lower GHG emissions. This is the first South African research to examine environmental impact on pasture-based dairy farms in this manner. It is possible for pasture-based dairy farmers to reduce the environmental impact of milk production by adopting some of the principles identified in this study

Has the phasing out of stavudine in accordance with changes in WHO guidelines led to a decrease in single-drug substitutions in first-line antiretroviral therapy for HIV in sub-Saharan Africa?

This version is the Accepted Manuscript and is published in final edited form as: AIDS. 2017 January 02; 31(1): 147–157. doi:10.1097/QAD.0000000000001307OBJECTIVE: We assessed the relationship between phasing out stavudine in first-line antiretroviral therapy (ART) in accordance with WHO 2010 policy and single-drug substitutions (SDS) (substituting the nucleoside reverse transcriptase inhibitor in first-line ART) in sub-Saharan Africa. DESIGN: Prospective cohort analysis (International epidemiological Databases to Evaluate AIDS-Multiregional) including ART-naive, HIV-infected patients aged at least 16 years, initiating ART between January 2005 and December 2012. Before April 2010 (July 2007 in Zambia) national guidelines called for patients to initiate stavudine-based or zidovudine-based regimen, whereas thereafter tenofovir or zidovudine replaced stavudine in first-line ART. METHODS: We evaluated the frequency of stavudine use and SDS by calendar year 2004-2014. Competing risk regression was used to assess the association between nucleoside reverse transcriptase inhibitor use and SDS in the first 24 months on ART. RESULTS: In all, 33 441 (8.9%; 95% confience interval 8.7-8.9%) SDS occurred among 377 656 patients in the first 24 months on ART, close to 40% of which were amongst patients on stavudine. The decrease in SDS corresponded with the phasing out of stavudine. Competing risks regression models showed that patients on tenofovir were 20-95% less likely to require a SDS than patients on stavudine, whereas patients on zidovudine had a 75-85% decrease in the hazards of SDS when compared to stavudine. CONCLUSION: The decline in SDS in the first 24 months on treatment appears to be associated with phasing out stavudine for zidovudine or tenofovir in first-line ART in our study. Further efforts to decrease the cost of tenofovir and zidovudine for use in this setting is warranted to substitute all patients still receiving stavudine

Monitoring the South African National Antiretroviral Treatment Programme, 2003 - 2007: The IeDEA Southern Africa collaboration

Objectives. To introduce the combined South African cohortsof the International epidemiologic Databases to EvaluateAIDS Southern Africa (IeDEA-SA) collaboration as reflectingthe South African national antiretroviral treatment (ART)programme; to characterise patients accessing these services;and to describe changes in services and patients from 2003 to2007.Design and setting. Multi-cohort study of 11 ART programmesin Gauteng, Western Cape, Free State and KwaZulu-Natal.Subjects. Adults and children

High HIV prevalence in an early cohort of hospital admissions with COVID-19 in Cape Town, South Africa

Background. South Africa (SA) has a high prevalence of HIV and tuberculosis. Cape Town was the SA metropole most affected in the early stages of the COVID-19 pandemic. Early observational data from Africa may provide valuable insight into what can be expected as the pandemic expands across the continent.Objectives. To describe the prevalence, clinical features, comorbidities and outcome of an early cohort of HIV-positive and HIV-negative patients admitted with COVID-19.Methods. This was a descriptive observational study of an early cohort of adults with COVID-19 pneumonia admitted from 25 March to 11 May 2020.Results. Of 116 patients (mean age 48 years, 61% female) admitted, 24 were HIV-positive (21%). The most common symptoms reported were cough (n=88; 73%), shortness of breath (n=78; 69%), fever (n=67; 59%), myalgia (n=29; 25%) and chest pain (n=22; 20%). The most common comorbidities were hypertension (n=46; 41%), diabetes mellitus (n=43; 38%), obesity (n=32; 28%) and HIV (n=24; 21%). Mortality was associated with older age (mean (standard deviation) 55 (12) years v. 46 (14) years; p<0.01); the presence of hypertension or hypertension along with diabetes and/or obesity; lower partial pressure of arterial oxygen to fraction of inspired oxygen ratio; and higher urea level, white cell count, neutrophil count, and C-reactive protein, lactate dehydrogenase and ferritin levels, and high neutrophil to lymphocyte ratio. The overall survival rate for all hospital admissions was 86/116 (73%). In this early cohort, survival was similar in patients with HIV (n=18; 75%) compared with those without HIV (n=67; 75%) (p=1). Of the 74 patients admitted to the wards, 63 (85%) survived, whereas 22 of 42 (52%) admitted to the intensive care unit survived.Conclusions. Patients with HIV infection represented a large proportion of all COVID-19 admissions. The presentation and outcome of patients with HIV did not differ significantly from those of patients without HIV

The impact of delayed switch to second-line antiretroviral therapy on mortality, depending on failure time definition and CD4 count at failure

Little is known about the functional relationship of delaying second-line treatment initiation for HIV-positive patients and mortality, given a patient’s immune status. We included 7255 patients starting antiretroviral therapy between 2004-2017, from 9 South African cohorts, with virological failure and complete baseline data. We estimated the impact of switch time on the hazard of death using inverse probability of treatment weighting (IPTW) of marginal structural models. The non-linear relationship between month of switch and the 5-year survival probability, stratified by CD4 count at failure, was estimated with targeted maximum likelihood estimation (TMLE). We adjusted for measured time-varying confounding by CD4 count, viral load and visit frequency. 5-year mortality was estimated as 10.5% (2.2%; 18.8%) for immediate switch and as 26.6% (20.9%; 32.3%) for no switch (49.9% if CD4 count<100 cells/mm3). The hazard of death was estimated to be 0.40 (95%CI: 0.33-0.48) times lower if everyone had been switched immediately compared to never. The shorter the delay in switching, the lower the hazard of death, e.g. delaying 30-60 days reduced the hazard 0.52 (0.41-0.65) times, and 60-120 days 0.56 (0.47-0.66) times. Early treatment switch is particularly important for patients with low CD4 counts at failure

Perinatal mortality in lambs of ewes exposed to cultures of Diplodia maydis (= Stenocarpella maydis) during gestation

During 1987 when cob rot was rife, perinatal losses were reported in flocks and herds that had been exposed to diplodiosis. The affected lambs or calves were either stillborn or died soon after birth. Dosing trials at the Onderstepoort Veterinary Research Institute involving 82 ewes revealed that 66% of the offspring of dams exposed to cultures of Diplodia maydis (= Stenocarpella maydis) in the second trimester of pregnancy and 87% of lambs of ewes exposed in the third trimester were born dead or died soon afterwards. A status spongiosus similar to that of the field cases was present in the white matter of the brains of all the affected lambs. The lambs of ewes that had shown nervous signs and those of ewes that had not shown such signs were equally affected. The experiments also clearly demonstrated that foetuses were much more susceptible to diplodiosis than the adults, e.g. in the third trimester 87% of the lambs were affected compared to only 44% of the dams. No perinatal mortalities were recorded in the group exposed to the culture in the first trimester. Ewes developed significant resistance to intoxication after initial exposure to the culture and both the length of gestation and birth mass of the affected lambs were less than those of their untreated counterparts.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.mn201

Leadership and early strategic response to the SARS-CoV-2 pandemic at a COVID-19 designated hospital in South Africa

While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SAgovernment announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes