Migration and first-year maternal mortality among HIV-positive postpartum women: A population-based longitudinal study in rural South Africa

Background In South Africa, within-country migration is common. Mobility affects many of the factors in the pathway for entry to or retention in care among people living with HIV. We characterized the patterns of migration (i.e., change in residency) among peripartum women from rural South Africa and their association with first-year postpartum mortality. Methods and findings All pregnant women aged ≥15 years were followed-up during pregnancy and the first year postpartum in a population-based longitudinal demographic and HIV surveillance program in KwaZulu-Natal, South Africa, from 2000 to 2016. During the household surveys (every 4–6 months), each household head was interviewed to record demographic components of the household, including composition, migration, and mortality. External migration was defined as moving (i.e., change in residency) into or out of the study area. For women of reproductive age, detailed information on new pregnancy and birth was recorded. Maternal death was ascertained via verbal autopsy and HIV status at delivery via annual HIV surveys. We fitted mixed-effects Cox regression models adjusting for multiple pregnancies per individual. Overall, 19,334 women had 30,291 pregnancies: 3,339 were HIV-positive, 10,958 were HIV-negative, and 15,994 had unknown HIV status at delivery. The median age was 24 (interquartile range: 20–30) years. During pregnancy and the first year postpartum, 64% (n = 19,344) and 13% (n = 3,994) did not migrate and resided within and outside the surveillance area, respectively. Of the 23% who had externally migrated at least once, 39% delivered outside the surveillance area. Overall, the mortality rate was 5.8 per 1,000 person-years (or 831 deaths per 100,000 live births) in the first year postpartum. The major causes of deaths were AIDS- or tuberculosis-related conditions both within 42 days of delivery (53%) and during the first year postpartum (62%). In this study, we observed that HIV-positive peripartum women who externally migrated and delivered outside the surveillance area had a hazard of mortality more than two times greater (hazard ratio = 2.74; 95% confidence interval 1.01–7.40, p-value = 0.047)—after adjusting for age, time period (before or after 2010), and sociodemographic status—compared to that of HIV-positive women who continuously resided within the surveillance area. Study limitations include lack of data on access to antiretroviral therapy (ART) care and social or clinical context at the destinations among mobile participants, which could lead to unmeasured confounding. Further information on how mobile postpartum women access and remain in care would be instructive. Conclusions In this study, we found that a substantial portion of peripartum women moved within the country around the time of delivery and experienced a significantly higher risk of mortality. Despite the scale-up of universal ART and declining trends in maternal mortality, there is an urgent need to derive a greater understanding of the mechanisms underlying this finding and to develop targeted interventions for mobile HIV-positive peripartum women

ANALISIS HUBUNGAN KELUHAN MSDs PADA PENGGUNA PELINDUNG PERNAPASAN SCSR DENGAN KELELAHAN KERJA

Keluhan Muskuloskeletal Disorders dan kelelahan kerja, merupakan faktor yang dapat menurunkan kondisi tubuh dalam beraktifitas atau kegiatan saat bekerja, sehingga dapat menambah kesalahan dalam melakukan pekerjaan dan bisa berakibat fatal yaitu mengakibatkan kecelakaan kerja. Faktor tersebut dapat menurunkan motivasi kerja, memperlambat waktu reaksi tubuh, mempersulit pengambilan keputusan, menurunkan kinerja dan meningkatkan kesalahan. Tujuan dari penelitian ini menganalisis adakah hubungan antara Keluhan Musculoskeletal Disorders pada pengguna pelindung pernapasan SCSR dengan Kelelahan Kerja. Penelitian ini merupakan penelitian observasional deskriptif dengan desain cross sectional. Sampel penelitian berjumlah 90 orang dari PT. XYZ. Variabel independen dari penelitian ini adalah Keluhan Muskuloskeletal Disorders dan variabel dependennya adalah kelelahan kerja. Alat ukur yang digunakan dalam penelitian ini adalah menggunakan Kuesioner dengan skala likert dan kuesioner NBM, Analisis data menggunakan Chi Square. Berdasarkan hasil analisis data menggunakan uji Chi-Square, diperoleh p-value = 0,018 yaitu Ada hubungan antara Keluhan Musculoskeletal Disorder dengan keluhan kelelahan kerja. Disarankan untuk perusahaan meningkatkan kembali pelatihan kelelahan kerja, mengembangkan standar operasional prosedur tetap pada yang berkaitan dengan kelelahan kerja, merekomendasikan design baru dan melakukan rotasi area kerja atau equipment yang berpotensi tinggi menyebabkan kelelahan kerja tinggi

Need for timely paediatric HIV treatment within primary health care in rural South Africa

<p>Background: In areas where adult HIV prevalence has reached hyperendemic levels, many infants remain at risk of acquiring HIV infection. Timely access to care and treatment for HIV-infected infants and young children remains an important challenge. We explore the extent to which public sector roll-out has met the estimated need for paediatric treatment in a rural South African setting.</p> <p>Methods: Local facility and population-based data were used to compare the number of HIV infected children accessing HAART before 2008, with estimates of those in need of treatment from a deterministic modeling approach. The impact of programmatic improvements on estimated numbers of children in need of treatment was assessed in sensitivity analyses.</p> <p>Findings: In the primary health care programme of HIV treatment 346 children <16 years of age initiated HAART by 2008; 245(70.8%) were aged 10 years or younger, and only 2(<1%) under one year of age. Deterministic modeling predicted 2,561 HIV infected children aged 10 or younger to be alive within the area, of whom at least 521(20.3%) would have required immediate treatment. Were extended PMTCT uptake to reach 100% coverage, the annual number of infected infants could be reduced by 49.2%.</p> <p>Conclusion: Despite progress in delivering decentralized HIV services to a rural sub-district in South Africa, substantial unmet need for treatment remains. In a local setting, very few children were initiated on treatment under 1 year of age and steps have now been taken to successfully improve early diagnosis and referral of infected infants.</p&gt

Validating child vaccination status in a demographic surveillance system using data from a clinical cohort study: evidence from rural South Africa

<p><b>Background:</b> Childhood vaccination coverage can be estimated from a range of sources. This study aims to validate vaccination data from a longitudinal population-based demographic surveillance system (DSS) against data from a clinical cohort study.</p> <p><b>Methods:</b> The sample includes 821 children in the Vertical Transmission cohort Study (VTS), who were born between December 2001 and April 2005, and were matched to the Africa Centre DSS, in northern KwaZulu-Natal. Vaccination information in the surveillance was collected retrospectively, using standardized questionnaires during bi-annual household visits, when the child was 12 to 23 months of age. DSS vaccination information was based on extraction from a vaccination card or, if the card was not available, on maternal recall. In the VTS, vaccination data was collected at scheduled maternal and child clinic visits when a study nurse administered child vaccinations. We estimated the sensitivity of the surveillance in detecting vaccinations conducted as part of the VTS during these clinic visits.</p> <p><b>Results:</b> Vaccination data in matched children in the DSS was based on the vaccination card in about two-thirds of the cases and on maternal recall in about one-third. The sensitivity of the vaccination variables in the surveillance was high for all vaccines based on either information from a South African Road-to-Health (RTH) card (0.94-0.97) or maternal recall (0.94-0.98). Addition of maternal recall to the RTH card information had little effect on the sensitivity of the surveillance variable (0.95-0.97). The estimates of sensitivity did not vary significantly, when we stratified the analyses by maternal antenatal HIV status. Addition of maternal recall of vaccination status of the child to the RTH card information significantly increased the proportion of children known to be vaccinated across all vaccines in the DSS.</p> <p><b>Conclusion:</b> Maternal recall performs well in identifying vaccinated children aged 12-23 months (both in HIV-infected and HIV-uninfected mothers), with sensitivity similar to information extracted from vaccination cards. Information based on both maternal recall and vaccination cards should be used if the aim is to use surveillance data to identify children who received a vaccination.</p&gt

Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004–12: a prospective cohort study

Background Studies of HIV-serodiscordant couples in stable sexual relationships have provided convincing evidence that antiretroviral therapy can prevent the transmission of HIV. We aimed to quantify the preventive eff ect of a publicsector HIV treatment and care programme based in a community with poor knowledge and disclosure of HIV status, frequent migration, late marriage, and multiple partnerships. Specifi cally, we assessed whether an individual’s hazard of HIV acquisition was associated with antiretroviral therapy coverage among household members of the opposite sex. Methods In this prospective cohort study, we linked patients’ records from a public-sector HIV treatment programme in rural KwaZulu-Natal, South Africa, with population-based HIV surveillance data collected between 2004 and 2012. We used information about coresidence to construct estimates of HIV prevalence and antiretroviral therapy coverage for each household. We then regressed the time to HIV seroconversion for 14 505 individuals, who were HIV-uninfected at baseline and individually followed up over time regarding their HIV status, on opposite-sex household antiretroviral therapy coverage, controlling for household HIV prevalence and a range of other potential confounders. Findings 2037 individual HIV seroconversions were recorded during 54 845 person-years of follow-up. For each increase of ten percentage points in opposite-sex household antiretroviral therapy coverage, the HIV acquisition hazard was reduced by 6% (95% CI 2–9), after controlling for other factors. This eff ect size translates into large reductions in HIV acquisition hazards when household antiretroviral therapy coverage is substantially increased. For example, an increase of 50 percentage points in household antiretroviral therapy coverage (eg, from 20% to 70%) reduced the hazard of HIV acquisition by 26% (95% CI 9–39). Interpretation Our fi ndings provide further evidence that antiretroviral therapy signifi cantly reduces the risk of onward transmission of HIV in a real-world setting in sub-Saharan Africa. Awareness that antiretroviral therapy can prevent transmission to coresident sexual partners could be a powerful motivator for HIV testing and antiretroviral treatment uptake, retention, and adherence. Funding Wellcome Trust and National Institute of Child Health and Human Development (US National Institutes of Health)

Spatial clustering of drug-resistant tuberculosis in Hlabisa subdistrict, KwaZulu-Natal, 2011-2015.

SETTING: Incidencerates of tuberculosis (TB) in South Africa are among the highest in the world, and drug resistance is a major concern. Understanding geographic variations in disease may guide targeted interventions. OBJECTIVE: To characterise the spatial distribution of drug-resistant TB (DR-TB) in a rural area of KwaZulu-Natal, South Africa, and to test for clustering. DESIGN: This was a cross-sectional analysis of DR-TB patients managed at a rural district hospital from 2011 to 2015. We mapped all patients in hospital data to local areas, and then linked to a population-based demographic surveillance system to map the patients to individual homesteads. We used kernel density estimation to visualise the distribution of disease and tested for clustering using spatial scan statistics. RESULTS: There were 489 patients with DR-TB in the subdistrict; 111 lived in the smaller demographic surveillance area. Spatial clustering analysis identified a high-risk cluster (relative risk of DR-TB inside vs. outside cluster 3.0, P < 0.001) in the south-east, a region characterised by high population density and a high prevalence of human immunodeficiency virus infection. CONCLUSION: We have demonstrated evidence of a geographic high-risk cluster of DR-TB. This suggests that targeting interventions to spatial areas of highest risk, where transmission may be ongoing, could be effective

The application of a landscape diversity index using remote sensing and geographical information systems to identify degradation patterns in the Great Fish River Valley, Eastern Cape Province, South Africa

Using a range of satellite-derived indices I describe. monitor and predict vegetation conditions that exist in the Great Fish River Valley, Eastern Cape. The heterogeneous nature of the area necessitates that the mapping of vegetation classes be accomplished using a combination of a supervised approach, an unsupervised approach and the use of a Moving Standard Deviation Index (MSDI). Nine vegetation classes are identified and mapped at an accuracy of 84%. The vegetation classes are strongly related to land-use and the communal areas demonstrate a reduction in palatable species and a shift towards dominance by a single species. Nature reserves and commercial rangeland are by contrast dominated by good condition vegetation types. The Modified Soil Adjusted Vegetation Index (MSA VI) is used to map the vegetation production in the study area. The influence of soil reflectance is reduced using this index. The MSA VI proves to be a good predictor of vegetation condition in the higher rainfall areas but not in the more semi-arid regions. The MSA VI has a significant relationship to rainfall but no absolute relationship to biomass. However, a stratification approach (on the basis of vegetation type) reveals that the MSA VI exhibits relationships to biomass in vegetation types occurring in the higher rainfall areas and consisting of a large cover of shrubs. A technique based on an index which describes landscape spatial variability is presented to assist in the interpretation of landscape condition. The research outlines a method for degradation assessment which overcomes many of the problems associated with cost and repeatability. Indices that attempt to provide a correlation with net primary productivity, e.g. NDVI, do not consider changes in the quality of net primary productivity. Landscape variability represents a measure of ecosystem change in the landscape that underlies the degradation process. The hypothesis is that healthy/undisturbed/stable landscapes tend to be less variable and homogenous than their degraded heterogenous counterparts. The Moving Standard Deviation Index (MSDI) is calculated by performing a 3 x 3 moving standard deviation window across Landsat Thematic Mapper (TM) band 3. The result is a sensitive indicator of landscape condition which is not affected by moisture availability and vegetation type. The MSDI shows a significant negative relationship to NDVI confirming its relationship to condition. The cross-classification of MSDI with NDVI allows the identification of invasive woody weeds which exhibit strong photosynthetic signals and would therefore be categorised as good condition using NDVI. Other ecosystems are investigated to determine the relationship between NDVI and MSDI. Where increase in NDVI is disturbance-induced (such as the Kalahari Desert) the relationship is positive. Where high NDVI values are indicative of good condition rangeland (such as the Fish River Valley) the relationship is negative. The MSDI therefore always exhibits a significant positive relationship to degradation irrespective of the relationship of NDVI to condition in the ecosystem

Antiretroviral therapy to prevent HIV acquisition in serodiscordant couples in a hyperendemic community in rural South Africa

Background. Antiretroviral therapy (ART) was highly efficacious in preventing human immunodeficiency virus (HIV) transmission in stable serodiscordant couples in the HPTN-052 study, a resource-intensive randomized controlled trial with near-perfect ART adherence and mutual HIV status disclosure among all participating couples. However, minimal evidence exists of the effectiveness of ART in preventing HIV acquisition in stable serodiscordant couples in "real-life" population-based settings in hyperendemic communities of sub-Saharan Africa, where health systems are typically resource-poor and overburdened, adherence to ART is often low, and partners commonly do not disclose their HIV status to each other. Methods. Data arose from a population-based open cohort in KwaZulu-Natal, South Africa. A total of 17 016 HIV-uninfected individuals present between January 2005 and December 2013 were included. Interval-censored time-updated proportional hazards regression was used to assess how the ART status affected HIV transmission risk in stable serodiscordant relationships. Results. We observed 1619 HIV seroconversions in 17 016 individuals, over 60 349 person-years follow-up time. During the follow-up period, 1846 individuals had an HIV-uninfected and 196 had an HIV-infected stable partner HIV incidence was 3.8/100 person-years (PY) among individuals with an HIV-infected partner (95% confidence interval [CI], 2.3-5.6), 1.4/100 PY (.4-3.5) among those with HIV-infected partners receiving ART, and 5.6/100 PY (3.5-8.4) among those with HIV-infected partners not receiving ART. Use of ART was associated with a 77% decrease in HIV acquisition risk among serodiscordant couples (adjusted hazard ratio, 0.23; 95% CI,. 07-.80). Conclusions. ART initiation was associated with a very large reduction in HIV acquisition in serodiscordant couples in rural KwaZulu-Natal. However, this "real-life" effect was substantially lower than the effect observed in the HPTN-052 trial. To eliminate HIV transmission in serodiscordant couples, additional prevention interventions are probably needed

Levels of childhood vaccination coverage and the impact of maternal HIV status on child vaccination status in rural KwaZulu-Natal, South Africa*

Objectives To analyse coverage of childhood vaccinations in a rural South African population and investigate whether maternal HIV status is associated with children’s vaccination status. Methods 2 431 children with complete information, 12–23 months of age at some point during the period January 2005 through December 2006 and resident in the Africa Centre Demographic Surveillance Area at the time of their birth were investigated. We examined the relationship between maternal HIV status and child vaccination status for five vaccinations [Bacillus Calmette‐Guérin (BCG), diphtheria‐tetanus‐pertussis (DTP3), poliomyelitis (polio3), hepatitis B (HepB3), and measles] in multiple logistic regressions, controlling for household wealth, maternal age, maternal education and distances to roads, fixed and mobile clinics. Results Coverage of the five vaccinations ranged from 89.3% (95% CI 81.7–93.9) for BCG to 77.3% (67.1–83.6) for measles. Multivariably, maternal HIV‐positive status was significantly associated with lower adjusted odds ratios (AOR) of child vaccination for all vaccines [(AOR) 0.60–0.74, all P ≤ 0.036] except measles (0.75, P = 0.073), distance to mobile clinic was negatively associated with vaccination status (all P ≤ 0.029), household wealth was positively (all P ≤ 0.013) and distance to nearest road negatively (all P ≤ 0.004) associated with vaccination status. Conclusion Positive maternal HIV status independently reduces children’s probability to receive child vaccinations, which likely contributes to the morbidity and mortality differential between children of HIV‐positive and HIV‐negative mothers. As a means of increasing vaccination coverage, policy makers should consider increasing the number of mobile clinics in this and similar communities in rural Africa