Elevated salivary C-reactive protein predicted by low cardio-respiratory fitness and being overweight in African children

INTRODUCTION: C-reactive protein (CRP) is a sensitive marker of systemic inflammation and is an independent risk factor for cardiovascular disease. The aim of the study was to examine the relationship between salivary CRP, cardio-respiratory fitness and body composition in a paediatric population. METHODS: This was a cross-sectional study of 170 black South African children (age 9.41 ± 1.55 years, 100 females, 70 males) in grades 3 to 7. Unstimulated whole saliva samples were obtained for the analysis of CRP. Height, mass, skin-fold thickness, resting blood pressure, and waist and hip circumference measurements were obtained. Cardio-respiratory fitness was assessed using a 20-m multi-stage shuttle run. Children were classified as overweight/obese according to the Center for Disease Control and Prevention (CDC) body mass index (BMI) percentile ranking, and meeting percentage body fat recommendations, if percentage body fat was ≤ 25% in boys and ≤ 32% in girls. The cut-off point for low cardio-respiratory fitness was a predicted aerobic capacity value ≤ the 50th percentile for the group. Contributions of low cardio-respiratory fitness, overweight/obesity, and not meeting percentage body fat recommendations, to elevated salivary CRP (≥ 75th percentile) concentration and secretion rate were examined using binary logistic regression analysis with a backward stepwise selection technique based on likelihood ratios. RESULTS: Poor cardio-respiratory fitness was independently associated with elevated salivary CRP concentration (OR 3.9, 95% CI: 1.7–8.9, p = 0.001). Poor cardio-respiratory fitness (OR 2.7, 95% CI: 1.2–6.1, p = 0.02) and overweight/obesity (BMI ≥ 85th percentile) (OR 2.5, 95% CI: 1.1–5.9, p = 0.03) were independent predictors of elevated salivary CRP secretion rate. CONCLUSION: The results suggest a strong association between poor cardio-respiratory fitness and/or overweight/obesity and inflammatory status in children, based on elevated salivary CRP levels

Comparing laboratory costs of smear/culture and Xpert(®) MTB/RIF-based tuberculosis diagnostic algorithms

SETTING: Cape Town, South Africa, where Xpert® MTB/RIF was introduced as a screening test for all presumptive tuberculosis (TB) cases. OBJECTIVE: To compare laboratory costs of smear/culture- and Xpert-based tuberculosis (TB) diagnostic algorithms in routine operational conditions. METHODS: Economic costing was undertaken from a laboratory perspective, using an ingredients-based costing approach. Cost allocation was based on reviews of standard operating procedures and laboratory records, timing of test procedures, measurement of laboratory areas and manager interviews. We analysed laboratory test data to assess overall costs and cost per pulmonary TB and multidrug-resistant TB (MDR-TB) case diagnosed. Costs were expressed as 2013 Consumer Price Index-adjusted values. RESULTS: Total TB diagnostic costs increased by 43%, from US$440 967 in the smear/culture-based algorithm (April–June 2011) to US$632 262 in the Xpert-based algorithm (April–June 2013). The cost per TB case diagnosed increased by 157%, from US$48.77 (n = 1601) to US$125.32 (n = 1281). The total cost per MDR-TB case diagnosed was similar, at US$190.14 and US$183.86, with 95 and 107 cases diagnosed in the respective algorithms. CONCLUSION: The introduction of the Xpert-based algorithm resulted in substantial cost increases. This was not matched by the expected increase in TB diagnostic efficacy, calling into question the sustainability of this expensive new technology

Improvements in the South African HIV care cascade: findings on 90-90-90 targets from successive population-representative surveys in North West Province.

IntroductionTo achieve epidemic control of HIV by 2030, countries aim to meet 90-90-90 targets to increase knowledge of HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression by 2020. We assessed the progress towards these targets from 2014 to 2016 in South Africa as expanded treatment policies were introduced using population-representative surveys.MethodsData were collected in January to March 2014 and August to November 2016 in Dr. Ruth Segomotsi Mompati District, North West Province. Each multi-stage cluster sample included 46 enumeration areas (EA), a target of 36 dwelling units (DU) per EA, and a single resident aged 18 to 49 per DU. Data collection included behavioural surveys, rapid HIV antibody testing and dried blood spot collection. We used weighted general linear regression to evaluate differences in the HIV care continuum over time.ResultsOverall, 1044 and 971 participants enrolled in 2014 and 2016 respectively with approximately 77% undergoing HIV testing. Despite increases in reported testing, known status among people living with HIV (PLHIV) remained similar at 68.7% (95% Confidence Interval (CI) = 60.9-75.6) in 2014 and 72.8% (95% CI = 63.6-80.4) in 2016. Men were consistently less likely than women to know their status. Among those with known status, PLHIV on ART increased significantly from 80.9% (95% CI = 71.9-87.4) to 91.5% (95% CI = 84.4-95.5). Viral suppression (<5000 copies/mL using DBS) among those on ART increased significantly from 55.0% (95% CI = 39.6-70.4) in 2014 to 81.4% (95% CI = 72.0-90.8) in 2016. Among all PLHIV an estimated 72.0% (95% CI = 63.8-80.1) of women and 45.8% (95% CI = 27.0-64.7) of men achieved viral suppression by 2016.ConclusionsOver a period during which fixed-dose combination was introduced, ART eligibility expanded, and efforts to streamline treatment were implemented, major improvements in the second and third 90-90-90 targets were achieved. Achieving the first 90 target will require targeted and improved testing models for men

Globalisation, neo-liberalism and vocational learning: the case of English further education colleges

Further education (FE) has traditionally been a rather unspectacular activity. Lacking the visibility of schools or the prestige of universities, for the vast majority of its existence FE has had a relatively low profile on the margins of English education. Over recent years this situation has altered significantly and further education has undergone profound change. This paper argues that a combination of related factors – neo-liberalism, globalisation, and dominant discourses of the knowledge economy – has acted in synergy to transform FE into a highly performative and marketised sector. Against this backdrop, further education has been assigned a particular role based upon certain narrow and instrumental understandings of skill, employment and economic competitiveness. The paper argues that, although it has always been predominantly working class in nature, FE is now, more than ever, positioned firmly at the lower end of the institutional hierarchy in the highly class-stratified terrain of English education

Reflecting Upon Ethical Imperatives for Scholarly Research and The Case of a South African University

A university’s reputation is built on the quality of its research and teaching output. Often a university with an established track record on research and teaching output can more easily access external funding and further improve on its ranking and standing amongst peers.  This enables it to attract and retain better quality students, academics and researchers.  Ideally, these staff and students in turn increase the quality of its research and thus a virtuous circle is created.  Therefore, it is understandable that universities in South Africa, as in most parts of the world, are constantly scrambling to increase their research output and enhance their research quality.  However, whenever issues of compromised academic integrity and unethical research practices arise, university management has often been unable to deal adequately with these issues.  This article concurs with the emerging argument among research scholars that it is insufficient to focus on ethical policies and guidelines without considering the culture of the institution. It argues that the ethical researcher needs to be supported by a dominant culture of academic integrity. The article then uses the case of South African university to illustrate this argument.

Comparing multidrug-resistant tuberculosis patient costs under molecular diagnostic algorithms in South Africa

SETTING: Ten primary health care facilities in Cape Town, South Africa, 2010–2013. OBJECTIVE: A comparison of costs incurred by patients in GenoType® MDRTBplus line-probe assay (LPA) and Xpert® MTB/RIF-based diagnostic algorithms from symptom onset until treatment initiation for multidrug-resistant tuberculosis (MDR-TB). METHODS: Eligible patients identified from laboratory and facility records were interviewed 3–6 months after treatment initiation and a cost questionnaire completed. Direct and indirect costs, individual and household income, loss of individual income and change in household income were recorded in local currency, adjusted to 2013 costs and converted to $US. RESULTS: Median number of visits to initiation of MDR-TB treatment was reduced from 20 to 7 (P < 0.001) and median costs fell from US$68.1 to US$38.3 (P = 0.004) in the Xpert group. From symptom onset to being interviewed, the proportion of unemployed increased from 39% to 73% in the LPA group (P < 0.001) and from 53% to 89% in the Xpert group (P < 0.001). Median household income decreased by 16% in the LPA group and by 13% in the Xpert group. CONCLUSION: The introduction of an Xpert-based algorithm brought relief by reducing the costs incurred by patients, but loss of employment and income persist. Patients require support to mitigate this impact

Sociodemographic and socioeconomic patterns of chronic non-communicable disease among the older adult population in Ghana

Background: In Ghana, the older adult population is projected to increase from 5.3% of the total population in 2015 to 8.9% by 2050. National and local governments will need information about non-communicable diseases (NCDs) in this population in order to allocate health system resources and respond to the health needs of older adults. Design: The 2007/08 Study on global AGEing and adult health (SAGE) Wave 1 in Ghana used face-to-face interviews in a nationally representative sample of persons aged 50-plus years. Individual respondents were asked about their overall health, diagnosis of 10 chronic non-communicable conditions, and common health risk factors. A number of anthropometric and health measurements were also taken in all respondents, including height, weight, waist and hip circumferences, and blood pressure (BP). Results: This paper includes 4,724 adults aged 50-plus years. The highest prevalence of self-reported chronic conditions was for hypertension [14.2% (95% CI 12.8–15.6)] and osteoarthritis [13.8%, (95% CI 11.7–15.9)]. The figure for hypertension reached 51.1% (95% CI 48.9–53.4) when based on BP measurement. The prevalence of current smokers was 8.1% (95% CI 7.0–9.2), while 2.0 (95% CI 1.5–2.5) were infrequent/frequent heavy drinkers, 67.9% (95% CI 65.2–70.5) consume insufficient fruits and vegetables, and 25.7% (95% CI 23.1–28.3) had a low level of physical activity. Almost 10% (95% CI 8.3–11.1) of adults were obese and 77.6% (95% CI 76.0–79.2) had a high-risk waist-to-hip ratio (WHR). Risks from tobacco and alcohol consumption continued into older age, while insufficient fruit and vegetable intake, low physical activity and obesity increased with increasing age. The patterns of risk factors varied by income quintile, with higher prevalence of obesity and low physical activity in wealthier respondents, and higher prevalence of insufficient fruit and vegetable intake and smoking in lower-income respondents. The multivariate analysis showed that only urban/rural residence and body mass index (BMI) were common determinates of both self-reported and measured hypertension, while all other determinants have differing patterns. Conclusions: The findings show a high burden of chronic diseases in the older Ghanaian population, as well as high rates of modifiable health risk factors. The government could consider targeting these health behaviors in conjunction with work to improve enrolment rates in the National Health Insurance Scheme

Bridging the transactional gap in Open Distance Learning (ODL): The case of the University of South Africa (Unisa)

The aim of this paper is to map and audit the availability and use of e-learning resources by Communication Science students at the University of South Africa (UNISA), in order to ensure that they provide a seamless learning experience to bridge the transactional distance in its Open Distance Learning (ODL) context. The Communication Science students targeted were COMSA executives and Unisa Radio employees. To serve the goal of the paper the following specific objectives were formulated: to establish types of e-learning resources available at Unisa, and to identify the benefits of elearning at Unisa. This study is informed by Michael Moore’s Transactional Distance theory. This theory, which focuses on dialogue, transactional distance and telecommunication systems, has been widely applied in many similar studies. A survey research design was used whereby questionnaires were administered to all COMSA executives and 50% of Unisa Radio student employees who were chosen using simple random sampling. The data gathered was analysed using thematic categorisation and tabulation and the findings were presented descriptively. The findings indicate that Unisa provides a variety of e-learning resources for its students. In addition, computers and the internet are most useful to students’ studies. It should be mentioned that e-learning facilitates and opens avenues for effective teaching. This study focused only on the availability and use of e-learning by Communication Science students at Unisa. Therefore, it will be necessary for a broader study to be undertaken which will focus on academic and ICT staff as well as students chosen across the Unisa community. Keywords: Open Distance Learning; E-learning; Online education; ICTs in teaching and learning, University of South Afric

Co-enrollment in multiple HIV prevention trials — Experiences from the CAPRISA 004 Tenofovir gel trial

Background: In settings where multiple HIV prevention trials are conducted in close proximity, trial participants may attempt to enroll in more than one trial simultaneously. Co-enrollment impacts on participant's safety and validity of trial results. We describe our experience, remedial action taken, inter-organizational collaboration and lessons learnt following the identification of co-enrolled participants. Experiences: Between February and April 2008, we identified 185 of the 398 enrolled participants as ineligible. In violation of the study protocol exclusion criteria, there was simultaneous enrollment in another HIV prevention trial (ineligible co-enrolled, n = 135), and enrollment of women who had participated in a microbicide trial within the past 12 months (ineligible not co-enrolled, n = 50). Following a complete audit of all enrolled participants, ineligible participants were discontinued via study exit visits from trial follow-up. Custom-designed education program on co-enrollment impacting on participants' safety and validity of the trial results was implemented. Shared electronic database between research units was established to enable verification of each volunteer's trial participation and to prevent future co-enrollments. Lessons learnt: Interviews with ineligible enrolled women revealed that high-quality care, financial incentives, altruistic motives, preference for sex with gel, wanting to increase their likelihood of receiving active gel, perceived low risk of discovery and peer pressure are the reasons for their enrollment in the CAPRISA 004 trial. Conclusion: Instituting education programs based on the reasons reported by women for seeking enrollment in more than one trial and using a shared central database system to identify co-enrollments have effectively prevented further co-enrollments