An update on the management of breast cancer in Africa
- Authors: Vanderpuye, V , Grover, S , Hammad, N , Prabhakar, Pooja , Simonds, H , Olopade, F , Stefan, D C
- Date: 2017
- Subjects: Africa Cancer--Treatment
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6048 , vital:45108 , DOI 10.1186/s13027-017-0124-y
- Description: There is limited information about the challenges of cancer management and attempts at improving outcomes in Africa. Even though South and North Africa are better resourceds to tackle the burden of breast cancer, similar poor prognostic factors are common to all countries. The five-year overall Survival rate for breast cancer patients does not exceed 60% for any low and middle-income country (LMIC) in Africa. In spite of the gains achieved over the past decade, certain characteristics remain the same such as limited availability of breast conservation therapies, inadequate access to drugs, few oncology specialists and adherence to harmful socio-cultural practices. This review on managing breast cancer in Africa is authored by African oncologists who practice or collaborate in Africa and with hands-on experience with the realities. A search was performed via electronic databases from 1999 to 2016. (PubMed/Medline, African Journals Online) for all literature in English or translated into English, covering the terms "breast cancer in Africa and developing countries". One hundred ninety were deemed appropriate. Breast tumors are diagnosed at earlier ages and later stages than in highincome countries. There is a higher prevalence of triple-negative cancers. The limitations of poor nursing care and surgery, inadequate access to radiotherapy, poor availability of basic and modern systemic therapies translate into lower survival rate. Positive strides in breast cancer management in Africa include increased adaptation of treatment guidelines, improved pathology services including immuno-histochemistry, expansion and upgrading of radiotherapy equipment across the continent in addition to more research opportunities. This review is an update of the management of breast cancer in Africa, taking a look at the epidemiology, pathology, management resources, outcomes, research and limitations in Africa from the perspective of oncologists with local experience.
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Beyond health care providers’recommendations: understandinginfluences on infant feeding choices ofwomen with HIV in the Eastern Cape,South Africa
- Authors: Adeniyi, Oladele Vincent , Ajayi, Anthony Idowu , Issah, Moshood , Owolabi, Eyitayo Omolara , Ter Goon, Daniel , Avramovic, Gordana , Lambert, John
- Date: 2017
- Subjects: Africa Infant Feeding Sub-sahara
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6063 , vital:45109 , https://doi.org/10.1186/s13006-019-0201-5
- Description: Background: Despite the array of studies on infant feeding practices of HIV-infected women, gaps still exist in the understanding of the underlying reasons for their infant feeding choices. Potential for behavioural change exists, especially in the light of the 2016 updated World Health Organization guideline on HIV and infant feeding. The aim of this paper is to determine the rate of adoption of exclusive breastfeeding in this cohort, examine the determinants of infant feeding choices of HIV-infected women and assess the underlying reasons for these choices. Methods: This was a mixed methods study conducted between September 2015 and May 2016. It analyses the quantitative and qualitative data of 1662 peripartum women enrolled in the East London Prospective Cohort Study across three large maternity services in the Eastern Cape. Women with HIV reported their preferred choices of infant feeding. In addition, participants explained the underlying reasons for their choices. Descriptive and inferential statistics summarised the quantitative data, while thematic content analysis was performed on qualitative data. Results: Of the 1662 women with complete responses, 80.3% opted to exclusively breastfeed their babies. In the adjusted model, up to grade 12 education level (AOR: 1.81; 95% CI: 1.14, 2.86), rural/peri-urban residence (AOR:1.44; 95% CI: 1.05, 1.96), alcohol use (AOR: 1.65; 95% CI: 1.25, 2.18), negative or unknown HIV status at booking (AOR:1.85; 95% CI:1.27, 2.70), currently married (AOR:1.43; 95% CI:1.01, 2.02) and WHO Clinical Stage 2–4 (AOR:1.77; 95% CI: 1.15, 2.72) were significantly associated with the decision to exclusively breastfeed. Health care providers’ recommendations, perceived benefits of breastfeeding, unaffordability of formula feeding, and coercion were the underlying reasons for wanting to breastfeed; while work/school-related demands, breast-related issues, and fear of infecting the baby influenced their decision to formula feed. Conclusion: The majority of HIV-infected women chose to breastfeed their babies in the Eastern Cape. Following up on these women to ensure they breastfeed exclusively, while also addressing their possible concerns, could be an important policy intervention. Future studies should focus on how early infant feeding decisions change over time, as well as the health outcomes for mother and child. Keywords: Exclusive breastfeeding, Infant feeding practice, infant formula feeding, HIV-infected peripartum women, South Africa, WHO guideline
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Biosynthesis of silver nanoparticles from Acacia mearnsii De Wild stem bark and its antinociceptive properties
- Authors: Avoseh, Opeyemi N , Oyedeji, Opeoluwa O , Aremu, Olukayode , Nkeh-Chungag, Benedicta N , Songca, Sandile P , Oyedeji, Adebola Omowunmi , Mohan, Sneha , Oluwafemi, Oluwatobi S
- Date: 2017
- Subjects: Metal nanoparticles , Acacia mearnsii , Nociceptive pain
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/1528 , vital:37774 , https://doi.org/10.1080/17518253.2017.1287310
- Description: The biosynthesis of silver nanoparticles (Ag-NPs) using the hydrosol extract of the dry stem bark of Acacia mearnsii as reducing and capping agents, and their antinociceptive properties are hereby reported. By varying the temperature and reaction time, the temporal evolution of the optical and morphological properties of the as-synthesized material was investigated. The NPs were characterized by UV–visible absorption spectroscopy, transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), energy-dispersive x-ray spectroscopy (EDS) and x-ray diffractometry (XRD) The optical analyses show that the position of the maximum surface plasmon resonance (SPR) peak is red-shifted as the reaction temperature decreased. The TEM micrographs show that the as-synthesized Ag-NPs are spherical while the X-ray diffraction shows that the material is highly crystalline with face-centered cubic structures. The anti-inflammatory efficacy, analyzed by the formalin model, indicates that the as-synthesized Ag-NPs are very effective, with an inhibition rate of about 76%.
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Calcium supplementation commencing before or early in pregnancy, or food fortification with calcium, for preventing hypertensive disorders of pregnancy
- Date: 2017
- Subjects: South Africa Pregnancy Journal article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6187 , vital:45261 , xlink:href="https://DOI:10.1002/14651858.CD011192.pub2"
- Description: Background Pre-eclampsia is considerably more prevalent in low- than high-income countries. One possible explanation for this discrepancy is dietary diKerences, particularly calcium deficiency. Calcium supplementation in the second half of pregnancy reduces the serious consequences of pre-eclampsia and is recommended by the WorldHealthOrganization (WHO) for women with low dietary calcium intake, but has limited eKect on the overallrisk of pre-eclampsia. It is important to establish whether calcium supplementation before and in early pregnancy has added benefit. Such evidence would be justification for population-level fortification of staple foods with calcium. Objectives To determine the eKect of calcium supplementation or food fortification with calcium, commenced before or early in pregnancy and continued at least until mid-pregnancy, on pre-eclampsia and other hypertensive disorders, maternal morbidity and mortality, as well as fetal and neonatal outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Trials Register (10 August 2017), PubMed (29 June 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (10 August 2017) and reference lists of retrieved studies. Selection criteria Randomised controlled trials of calcium supplementation orfood fortification which include women of child bearing age not yet pregnant, or in early pregnancy. Cluster-RCTs, quasi-RCTs and trials published in abstract form only would have been eligible for inclusion in this review but none were identified. Cross-over designs are not appropriate for this intervention. The scope of this review is to consider interventions including calcium supplementation with or without additional supplements or treatments, compared with placebo or no intervention. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results This review is based on one RCT (involving 60 women) which looked at calcium plus additional supplements versus control. The women (who had lowantioxidant status)were in the early stages of pregnancy.We did notidentify any studieswhere supplementation commenced pre-pregnancy. Another RCT comparing calcium versus placebo is ongoing but not yet complete. We did not identify any studies looking at any of our other planned comparisons. Calcium plus antioxidants and other supplements versus placebo We included one small study (involving 60 women with low antioxidantlevels) which was conducted in an academic hospital in Indondesia. The study was at low risk of bias for all domains with the exception of selective reporting, for which it was unclear. Women in the intervention group received calcium (800 mg) plus N-acetylcysteine (200 mg), Cu (2 mg), Zn (15 mg), Mn (0.5 mg) and selenium (100 mcg) and vitamins A (1000 IU), B6 (2.2 mg), B12 (2.2 mcg), C (200 mg), and E (400 IU) versus the placebo control group of women who received similar looking tablets containing iron and folic acid. Both groups received iron (30 mg) and folic acid (400 mcg). Tablets were taken twice daily from eight to 12 weeks of gestation and then throughout pregnancy. The included study found that calcium supplementation plus antioxidants and other supplements may slightly reduce pre-eclampsia (gestational hypertension and proteinuria) (risk ratio (RR) 0.24, 95% confidence interval (CI) 0.06 to 1.01; low-quality evidence), but this is uncertain due to wide confidence intervals just crossing the line of no eKect, and small sample size. It appears that earlypregnancy loss before 20 weeks' gestation (RR 0.06, 95% CI 0.00 to 1.04; moderate-quality evidence) may be slightly reduced by calcium plus antioxidants and other supplements, but this outcome also has wide confidence intervals, which just cross the line of no eKect. Very few events were reported under the composite outcome, severe maternal morbidity and mortality index and no clear diKerence was seen between groups (RR 0.36, 95% CI 0.04 to 3.23; low-quality evidence). However, the included study observed a reduction in the composite outcome pre-eclampsia and/or pregnancy loss at any gestational age (RR 0.13, 95% CI 0.03 to 0.50; moderate-quality evidence), and pregnancy loss/stillbirth at any gestational age (RR 0.06, 95% CI 0.00 to 0.92;moderate-quality evidence)in the calcium plus antioxidant/supplement group. Other outcomes reported (placental abruption, severe pre-eclampsia and preterm birth (less than 37 weeks' gestation)) were too infrequent for meaningful analysis. No data were reported for the outcomes caesarean section, birthweight less 2500 g, Apgar score less than seven at five minutes, death or admission to neonatal intensive care unit (ICU), or pregnancy loss, stillbirth or neonatal death before discharge from hospital. Authors' conclusions The results of this review are based on one small study in which the calcium intervention group also received antioxidants and other supplements. Therefore, we are uncertain whether any of the eKects observed in the study were due to calcium supplementation or not. The evidence in this review was graded low to moderate due to imprecision. There is insuKicient evidence on the eKectiveness or otherwise of pre- or early-pregnancy calcium supplementation, or food fortification for preventing hypertensive disorders of pregnancy. Furtherresearch is needed to determine whether pre- or early-pregnancy supplementation, orfood fortification with calcium is associated with a reduction in adverse pregnancy outcomes such as pre-eclampsia and pregnancy loss. Such studies should be adequately powered, limited to calcium supplementation, placebo-controlled, and include relevant outcomes such as those chosen for this review. There is one ongoing study of calcium supplementation alone versus placebo and this may provide additional evidence in future updates
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Calcium supplementation commencing before or early in pregnancy, or food fortification with calcium, for preventing hypertensive disorders of pregnancy
- Authors: Hofmeyr, Georges Justus , Manyame, S
- Date: 2017
- Subjects: South Africa Pregnancy Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6215 , vital:45282 , "https://DOI:10.1002/14651858.CD011192.pub2"
- Description: Background Pre-eclampsia is considerably more prevalent in low- than high-income countries. One possible explanation for this discrepancy is dietary diKerences, particularly calcium deficiency. Calcium supplementation in the second half of pregnancy reduces the serious consequences of pre-eclampsia and is recommended by the WorldHealthOrganization (WHO) for women with low dietary calcium intake, but has limited eKect on the overallrisk of pre-eclampsia. It is important to establish whether calcium supplementation before and in early pregnancy has added benefit. Such evidence would be justification for population-level fortification of staple foods with calcium. Objectives To determine the eKect of calcium supplementation or food fortification with calcium, commenced before or early in pregnancy and continued at least until mid-pregnancy, on pre-eclampsia and other hypertensive disorders, maternal morbidity and mortality, as well as fetal and neonatal outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Trials Register (10 August 2017), PubMed (29 June 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (10 August 2017) and reference lists of retrieved studies. Selection criteria Randomised controlled trials of calcium supplementation orfood fortification which include women of child bearing age not yet pregnant, or in early pregnancy. Cluster-RCTs, quasi-RCTs and trials published in abstract form only would have been eligible for inclusion in this review but none were identified. Cross-over designs are not appropriate for this intervention. The scope of this review is to consider interventions including calcium supplementation with or without additional supplements or treatments, compared with placebo or no intervention. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results This review is based on one RCT (involving 60 women) which looked at calcium plus additional supplements versus control. The women (who had lowantioxidant status)were in the early stages of pregnancy.We did notidentify any studieswhere supplementation commenced pre-pregnancy. Another RCT comparing calcium versus placebo is ongoing but not yet complete. We did not identify any studies looking at any of our other planned comparisons. Calcium plus antioxidants and other supplements versus placebo We included one small study (involving 60 women with low antioxidantlevels) which was conducted in an academic hospital in Indondesia. The study was at low risk of bias for all domains with the exception of selective reporting, for which it was unclear. Women in the intervention group received calcium (800 mg) plus N-acetylcysteine (200 mg), Cu (2 mg), Zn (15 mg), Mn (0.5 mg) and selenium (100 mcg) and vitamins A (1000 IU), B6 (2.2 mg), B12 (2.2 mcg), C (200 mg), and E (400 IU) versus the placebo control group of women who received similar looking tablets containing iron and folic acid. Both groups received iron (30 mg) and folic acid (400 mcg). Tablets were taken twice daily from eight to 12 weeks of gestation and then throughout pregnancy. The included study found that calcium supplementation plus antioxidants and other supplements may slightly reduce pre-eclampsia (gestational hypertension and proteinuria) (risk ratio (RR) 0.24, 95% confidence interval (CI) 0.06 to 1.01; low-quality evidence), but this is uncertain due to wide confidence intervals just crossing the line of no eKect, and small sample size. It appears that earlypregnancy loss before 20 weeks' gestation (RR 0.06, 95% CI 0.00 to 1.04; moderate-quality evidence) may be slightly reduced by calcium plus antioxidants and other supplements, but this outcome also has wide confidence intervals, which just cross the line of no eKect. Very few events were reported under the composite outcome, severe maternal morbidity and mortality index and no clear diKerence was seen between groups (RR 0.36, 95% CI 0.04 to 3.23; low-quality evidence). However, the included study observed a reduction in the composite outcome pre-eclampsia and/or pregnancy loss at any gestational age (RR 0.13, 95% CI 0.03 to 0.50; moderate-quality evidence), and pregnancy loss/stillbirth at any gestational age (RR 0.06, 95% CI 0.00 to 0.92;moderate-quality evidence)in the calcium plus antioxidant/supplement group. Other outcomes reported (placental abruption, severe pre-eclampsia and preterm birth (less than 37 weeks' gestation)) were too infrequent for meaningful analysis. No data were reported for the outcomes caesarean section, birthweight less 2500 g, Apgar score less than seven at five minutes, death or admission to neonatal intensive care unit (ICU), or pregnancy loss, stillbirth or neonatal death before discharge from hospital. Authors' conclusions The results of this review are based on one small study in which the calcium intervention group also received antioxidants and other supplements. Therefore, we are uncertain whether any of the eKects observed in the study were due to calcium supplementation or not. The evidence in this review was graded low to moderate due to imprecision. There is insuKicient evidence on the eKectiveness or otherwise of pre- or early-pregnancy calcium supplementation, or food fortification for preventing hypertensive disorders of pregnancy. Furtherresearch is needed to determine whether pre- or early-pregnancy supplementation, orfood fortification with calcium is associated with a reduction in adverse pregnancy outcomes such as pre-eclampsia and pregnancy loss. Such studies should be adequately powered, limited to calcium supplementation, placebo-controlled, and include relevant outcomes such as those chosen for this review. There is one ongoing study of calcium supplementation alone versus placebo and this may provide additional evidence in future updates
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Central obesity and normal-weight central obesity among adults attending healthcare facilities in Buffalo City Metropolitan Municipality, South Africa: a cross-sectional study
- Authors: Owolabi, Eyitayo Omolara , Ter Goon, Daniel , Adeniyi, Oladele Vincent
- Date: 2017
- Subjects: Buffalo City Metropolitan Municipality, South Africa Obesity Central obesity, Overall obesity, Waist circumference, Waist-to-hip ratio, Waist-to-height ratio, NICE BMI-WC composite index, Health risk, Abdominal obesity Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5887 , vital:44664 , https://DOI10.1186/s41043-017-0133-x
- Description: Background Central obesity (CO) confers a significant threat on the cardio-metabolic health of individuals, independently of overall obesity. Disparities in the measures of fat distribution lead to misclassification of individuals who are at risk of cardio-metabolic diseases. This study sought to determine the prevalence and correlates of central obesity and normal-weight central obesity among adults attending selected healthcare facilities in Buffalo City Metropolitan Municipality (BCMM), South Africa, assess their health risk and examine the association between central obesity and cardio-metabolic diseases among adults with normal weight, measured by body mass index (BMI). Methods A cross-sectional survey of 998 adults was carried out at the three largest outpatient clinics in BCMM. Overall and central obesity were assessed using BMI, waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHTR). The WHO STEPwise questionnaire was used for data collection. Blood pressure and blood glucose were measured. Normal-weight central obesity was defined as CO among individuals with normal weight, as assessed by BMI. Health risk levels were assessed using the National Institute for Health and Clinical Excellence (NICE) BMI-WC composite index. Bivariate and multivariate analyses were used to determine the prevalence of CO, normal-weight central obesity and the predictors of CO. Results The mean age of participants was 42.6 (± 16.5) years. The prevalence of CO was 67.0, 58.0 and 71.0% by WC, WHR and WHTR, respectively. The prevalence of normal-weight central obesity was 26.9, 36.9 and 29.5% by WC, WHR and WHTR, respectively. About 41% of the participants had a very high health risk, 13% had increased risk or high risk and 33% had no health risk. Central obesity was significantly associated with hypertension but not associated with diabetes among those with normal weight (by BMI). Female sex, age over 30 years, marriage, secondary or tertiary level of education, non-smoking status, diabetes and hypertension significantly predicted central obesity among the study participants. Conclusion The prevalence of central obesity among the study participants is high, irrespective of the defining criteria. One in three adults of normal weight had central obesity. Body mass index should therefore not be used alone for clinical assessment by healthcare workers in the study setting.
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Challenges of information and communication technology policy implementation in rural South Africa
- Authors: Chisango, Grasia , Lesame, Carol
- Date: 2017
- Subjects: Information society , Digital inclusion , Education
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5592 , vital:44611 , https://doi.org/10.18820/24150525/Comm.v22.4
- Description: While the South African government has implemented an information and communication technology (ICT) policy to address issues of universal access and service, questions remain about the effective implementation of this policy in rural areas. This article explores the extent to which ICT policy and regulation were implemented in rural South Africa, with specific reference to the Eastern Cape province. Focus group interviews and in-depth face-to-face interviews were conducted to collect qualitative data from 28 high school learners, two local municipal mayors and two women support group leaders in the Chris Hani District Municipality. A theme analysis indicated that the Universal Service and Access Agency of South Africa (USAASA) is failing to fulfil its mandate of promoting universal access and service. It is recommended that the provincial government in the Eastern Cape design an ICT strategy for its municipalities and that there should be easy access to Thusong Service Centres in rural areas.
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Facilitators for and barriers to the implementation of National Tuberculosis Management Guidelines
- Authors: Dlwati, Lucretia V , Mavundla, Thandisizwe R , Mbengo, Fungai
- Date: 2017
- Subjects: TB management , National Tuberculosis Management Guidelines , Normalization Process Model
- Language: English
- Type: article , text
- Identifier: http://hdl.handle.net/11260/5569 , vital:44607 , https://doi.org/10.25159/2520-5293/2862
- Description: The South African government developed the National Tuberculosis Management Guidelines (NTBMGs) to provide guidance to professional healthcare workers on the management of people with TB and also those co-infected with HIV. However, little is known about primary healthcare (PHC) nurses perceptions of the implementation of the NTBMGs, despite their critical role in TB management. The purpose of this study was to explore PHC nurses perception of the implementation of the NTBMGs in order to identify factors influencing the implementation of the NTBMGs and to make recommendations to improve the implementation of the NTBMGs. The study was conducted in the Eastern Cape, South Africa. The Normalization Process Model (NPM) was used as a theoretical framework to understand the factors influencing the implementation of the NTBMGs. A qualitative, explorative, descriptive and contextual research design was utilised. Data were collected using individual semi-structured interviews on a purposive sample of PHC nurses working in rural clinics. Data were analysed following a descriptive method of Tesch. The study revealed several facilitators for and barriers to the implementation of the NTBMGs based on the NPM. The facilitators included the PHC nurses satisfaction with the Directly Observed Treatment, Short Course (DOTS) strategy in rendering health services to TB patients, the PHC nurses perception of TB meetings as an appropriate platform for problem-solving, of the NTBMGs to be consistent with TB management, and of job satisfaction in relation to patient improvement. The barriers included poverty, inadequate training, shortage of staff, and a lack of material resources, a proper infection control policy, and space. There is a need for the provision of adequate human, material and infrastructural resources in order to eliminate the barriers to the implementation of the NTBMGs.
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Incidence of unnatural deaths in Transkei subregion of South Africa (1996 –2015)
- Date: 2017
- Subjects: South Africa Death 2078-6204 Journal article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6172 , vital:45258 , xlink:href=": https://doi.org/10.1080/20786190.2017.1292697"
- Description: Background: Unnatural deaths are a serious and preventable public health problem in South Africa. Such an event is more than the death of an individual who has died in an unnatural way. It has a negative and long-lasting impact on family members as well as on society as a whole. Objective: To study the pattern of unnatural deaths in the Transkei sub-region of South Africa. Method: A record review was undertaken from 1996 to 2015 of 24 693 medico-legal autopsies performed at Mthatha Forensic Pathology Laboratory. Results: At the Mthatha Forensic Pathology Laboratory, 24 693 autopsies were performed between 1996 and 2015 on people who had died unnatural deaths. The average rate of unnatural death is 205 per 100 000 per year in this region. The figure is 160 per 100 000 among males and 44 per 100 000 among females. The rate of unnatural death has increased from 153 per 100 000 in 1996 to 260 per 100 000 in 2015. In two-thirds (69%) of cases, the cause of death is related to trauma. Slightly less than half (45%) of the victims in this study were murdered. Conclusion: There is an increasing trend of unnatural deaths in the Mthatha region of South Africa. The male-to-female ratio is 3.8:1, and about half (48%) of the victims were between 11 and 30 years old. This situation needs the urgent attention of the law enforcement agencies. Keywords: unnatural deaths, traumatic deaths, violent death
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Objectivity of the subjective quality: Convergence on competencies expected of doctoral graduates
- Authors: Kariyana, Israel , Sonn, Reynold A. , Marongwe, Newlin
- Date: 2017
- Subjects: South Africa Doctoral students Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5794 , vital:44645 , https://DOI:10.1080/2331186X.2017.1390827
- Description: This study assessed the competencies expected of doctoral graduates. Twelve purposefully sampled education experts provided the data. A case study design within a qualitative approach was adopted. Data were gathered through interviews and thematically analysed. Member checking ensured data trustworthiness. Factors affecting the quality of a doctoral graduate were said to be embedded in characteristics of universities and doctoral students. Competencies expected of doctoral graduates included being autonomous researchers and knowledge producers and consumers. Measures to enhance competence of doctoral graduates comprised implementing rigorous institutional mandates and creating doctoral collaborative communities. The study recommends higher education institutions to pragmatically capacitate supervisors and implement rigorous institutional doctoral transformation programmes. Subjects: Information and Communication Technology (ICT); Social Sciences; Education; Humanities Keywords: doctoral graduates; competencies; supervisors; higher education institutions
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Omics-based molecular techniques in oral pathology centred cancer: prospect and challenges in Africa
- Authors: Adeola, Henry A. , Soyele, Olujide.O. , Adefuye, Anthonio O. , Jimoh, Sikiru A. , Butali, Azeez
- Date: 2017
- Subjects: Eastern Cape, South Africa Oral mucosa--Cancer Oral Pathology Cancer Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5857 , vital:44658 , https://DOI10.1186/s12935-017-0432-8
- Description: Background:The completion of the human genome project and the accomplished milestones in the human proteome project; as well as the progress made so far in computational bioinformatics and “big data” processing have contributed immensely to individualized/personalized medicine in the developed world.Main body:At the dawn of precision medicine, various omics-based therapies and bioengineering can now be applied accurately for the diagnosis, prognosis, treatment, and risk stratification of cancer in a manner that was hitherto not thought possible. The widespread introduction of genomics and other omics-based approaches into the postgraduate training curriculum of diverse medical and dental specialties, including pathology has improved the proficiency of practitioners in the use of novel molecular signatures in patient management. In addition, intricate details about disease disparity among different human populations are beginning to emerge. This would facilitate the use of tailor-made novel theranostic methods based on emerging molecular evidences.Conclusion:In this review, we examined the challenges and prospects of using currently available omics-based technologies vis-à-vis oral pathology as well as prompt cancer diagnosis and treatment in a resource limited setting.Keywords:Omics-based, Molecular, Developing world, Oral pathology, Challenges
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Prevalence and factors associated with tobacco use among adults attending selected healthcare facilities in Buffalo City Metropolitan Municipality, South Africa
- Authors: Owolabia, E O , Goona, D T , Adeniyi, Oladele Vincent , Seekoea, E , Adedokun, A O
- Date: 2017
- Subjects: South Africa Tobacco 2078-6204 Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6127 , vital:45127 , https://doi.org/10.1080/20786190.2017.1340251
- Description: Tobacco use increases the risk of cardiovascular disease, premature death and certain cancers. This study investigated the prevalence and determinants of tobacco use among adults in Buffalo City Metropolitan Municipality (BCMM), South Africa. Methods: This study forms part of the cardio-metabolic risk survey carried out at the three largest outpatient clinics in BCMM. This multi-centre cross-sectional survey utilised the relevant items of the WHO STEPwise questionnaire to obtain information on demographic and behavioural characteristics of 1 107 participants. A total of 109 participants were excluded as a result of incomplete data. Thus, 998 participants (male = 327; female = 671) were included in the analysis. Self-reported, current use of any tobacco product was defined as tobacco use while secondary smoking was defined as exposure of non-smokers to environmental tobacco smoke, either at home or in the workplace. Results: Of all the study participants, 150 (15%) were current tobacco users and 335 (39.5%) of the non-smoking participants were exposed to secondary smoking. The majority of the tobacco users were males (70.7%) compared with females (29.3%). The commonest form of tobacco use was the manufactured cigarette. The mean age at initiation of smoking was 18.3 ± 5.1 and 22.6 ± 8.0 years for men and women, respectively. Only male sex (p = 0.000), single status (p = 0.003), no formal education (p = 0.007) and self-employment (p = 0.043) were significantly associated with tobacco use. Conclusion: High prevalence of tobacco use, especially cigarette smoking, in BCMM is worrisome given its strong association with cardiovascular events and cancers. The district health authorities should prioritise smoking cessation measures at the primary health care level.
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Prevalence of metabolic syndrome in adolescents living in Mthatha, south africa
- Authors: Sekokotla, Annah , Goswami, Nandu , Sewani-Rusike, Constance Rufaro , Iputo, Jehu Erapu , Nkeh-Chungag, Benedicta Ngwenchi
- Date: 2017
- Subjects: South Africa Metabolic syndrome Journal article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5983 , vital:45061 , xlink:href="https://doi:10.2147/TCRM.S124291"
- Description: Objective Metabolic syndrome (MetS), defined as the clustering of three of five risk factors (hypertension, obesity, triglyceridemia, dyslipidemia and hyperglycemia), is being increasingly mentioned among children and adolescents despite there being no consensus on how it should be defined in this set of population. Furthermore, very few studies have focused on MetS in children and adolescents in sub-Saharan populations. This study, therefore, aimed at determining the prevalence of the MetS and contributing risk in adolescents living in Mthatha, South Africa. Research design and methods Four hundred and ten adolescents (age range: 13–18 years, both sexes) were recruited into this cross-sectional study. In addition to a lifestyle questionnaire being administered, anthropometric measurements (weight, height and waist circumferences) were carried out for each participant. Fasting venous blood was collected for lipid profile and blood glucose assessments. Blood pressure was also measured. MetS was assessed using appropriate diagnostic criteria for children and adolescents. Results Complete data sets were collected from 371 participants. Females showed an elevation in the risk factors for MetS. Of the 371 participants, 40.2% were overweight/obese (47.5% females; 22.5% males). MetS was diagnosed in 3.1% female participants compared with 6.0% in male participants. Conclusions More risk factors for the MetS are seen among the overweight/obese as compared to lean adolescents. Given the fact that childhood overweight/obesity often continues into adulthood, it is important to address the causes of increased risk for MetS earlier in life to prevent the development of disease in adult life.
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South African Learners’ Conceptual Understanding about Image Formation by Lenses
- Authors: John, Merlin , Molepo, Jacob Maisha , Chirwa, Max
- Date: 2017
- Subjects: South Africa Lenses Journal article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6000 , vital:45074 , xlink:href="https://doi.org/10.12973/eurasia.2017.00694a"
- Description: The purpose of this research was to explore South African Grade 11 learners’ conceptual understanding of ‘image formation by lenses’. The participants for this study were 70 Grade 11 learners from a selected senior secondary school in Mthatha, Eastern Cape Province, South Africa. The qualitative approach employed in the study made use of a two-tier open-ended questionnaire as the data collection instrument. The study explored several alternative conceptions the learners had held in terms of the roles that the lens and the screen play in the image formation and the characteristics of the image formed when a lens with a larger diameter is used and when a portion of the lens is covered. Most of the participants could not respond correctly in the situations presented in the questionnaire. However, almost all of them were found to have adequate conceptual understanding about the role of a lens in the image formation.
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The effect of the Xpert MTB/RIF test on the time to MDR-TB treatment initiation in a rural setting: a cohort study in South Africa’s Eastern Cape Province
- Authors: Iruedo, Joshua , O’Mahony , Don , Mabunda, Sikhumbuzo A , Wright, Graham , Cawe , Busisiwe
- Date: 2017
- Subjects: South Africa Multidrug-resistant tuberculosis Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6098 , vital:45115 , https://DOI10.1186/s12879-017-2200-8
- Description: Background: There are significant delays in initiation of multidrug-resistant tuberculosis (MDR –TB) treatment. The Xpert MTB/RIF test has been shown to reduce the time to diagnosis and treatment of MDR-TB predominantly in urban centres. This study describes the time to treatment of MDR-TB and the effect of Xpert MTB/RIF on time to treatment in a deprived rural area in South Africa. Methods: This was a retrospective cohort study analysing the medical records of patients diagnosed with MDR-TB in King Sabata Dalindyebo Sub-District between 2009 and 2014. Numerical data were reported using the Kruskal-Wallis and Wilcoxon sum rank tests and categorical data compared using the two-sample test of proportions. Results: Of the 342 patients with MDR-TB identified, 285 were eligible for analysis, of whom 145 (61.4%) were HIV positive. The median time from sputum collection to MDR-TB diagnosis was 27 days (IQR: 2–45) and differed significantly between diagnostic modalities: Xpert MTB/RIF, 1 day (IQR: 1–4; n = 114: p less 0.0001); Line Probe Assay 12 days (IQR: 8–21; n = 28; p less 0.0001); and culture/phenotypic drug sensitivity testing 45 days (IQR: 39–59; n = 143: p less 0.0001). The time from diagnosis to treatment initiation was 14 days (IQR: 8–27) and did not differ significantly between diagnostic modality. The median time from sputum collection to treatment initiation was 49 days (IQR: 20–69) but differed significantly between diagnostic modalities: Xpert MTB/RIF, 18 days (IQR: 11–27; n = 114; p less 0.0001); Line Probe Assay 29 days (IQR: 14.5–53; n = 28; p les 0.0001); and culture/phenotypic drug sensitivity, 64 days (IQR: 50–103; n = 143: P less 0.0001). Age, sex and HIV status did not influence the time intervals. Conclusions: Xpert MTB/RIF significantly reduced the time to MDR-TB treatment in a deprived rural setting as a result of a reduced time to diagnosis. However, the national target of five days was not achieved. Further research is needed to explore and address programmatic and patient-related challenges contributing to delayed treatment initiation. Keywords: Xpert MTB/RIF, MDR-TB, Rural, Time-to-treatment, Cohort study
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Tourism entrepreneurship: the contours of challenges faced by female-owned BnBs and Guesthouses in Mthatha, South Africa
- Authors: Hlanyane, Tabisa Monalisa , Acheampong, Kofi Owusu
- Date: 2017
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6563 , vital:46659 , https://www.ajhtl.com/uploads/7/1/6/3/7163688/article_50_vol_6__4__2017.pdf
- Description: The purpose of the study was to investigate and discover the facts about the challenges of female entrepreneurs who are the owners of bed and breakfasts and guesthouses in Mthatha, and to find out whether these challenges have an impact in their business performance. By way of using a semi-structured survey, women who own guesthouses and bed and breakfast establishments were targeted by way of a purposive snowball sampling technique. The primary data collected indicated that female-entrepreneurs in Mthatha face a number of challenges including limited access to finance, seasonality, balancing work and family life, corruption/bribery, poor infrastructure, inability to attend seminars and workshops to network, poor customer service and lack of awareness to the required training/skills to function effectively. However, such women remain resilient to the aforementioned challenges, largely motivated by such factors linked to flexibility, the quest to remain independent and the belief in the opportunity and financial incentives that their operation represents. This study has implications for entrepreneurship and economic growth in South Africa and how vulnerable businesses including women’s require continuous support from government and private sector to remain competitive and economically sustainable.ackground:Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant womenliving with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention ofmother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examinedadherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in thePMTCT programme in the Eastern Cape, South Africa.Methods:This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. Weconducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016.Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n= 177)were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used todetermine the independent predictors of ART non-adherence.Results:A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, afteradjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family memberwere the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the mainreasons for non-adherence to ART.Conclusions:Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated withlifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV,clinicians need to screen for these factors at every antenatal clinic visit.Keywords:Adherence, Non-adherence, HIV, Antiretroviral therapy, Elimination of mother-to-child transmission,Prevention of mother-to-child transmission, Stigma, South Africa
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Using iterative learning to improve understanding during the informed consent process in a South African psychiatric genomics study
- Authors: Campbell, Megan M , Susser, Ezra , Mall, Sumaya , Mqulwana, Sibonile G , Mndini, Michael M , Ntola, Odwa A , Nagdee, Mohamed , Zingela, Zukiswa , Van Wyk, Stephanus , Stein, Dan J
- Date: 2017
- Subjects: Informed consent (Medical law) , Patient education
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6114 , vital:45124 , https://doi.org/10.1371/journal.pone.0188466
- Description: Obtaining informed consent is a great challenge in global health research. There is a need for tools that can screen for and improve potential research participants’ understanding of the research study at the time of recruitment. Limited empirical research has been conducted in low and middle income countries, evaluating informed consent processes in genomics research. We sought to investigate the quality of informed consent obtained in a South African psychiatric genomics study. A Xhosa language version of the University of California, San Diego Brief Assessment of Capacity to Consent Questionnaire (UBACC) was used to screen for capacity to consent and improve understanding through iterative learning in a sample of 528 Xhosa people with schizophrenia and 528 controls. We address two questions: firstly, whether research participants’ understanding of the research study improved through iterative learning; and secondly, what were predictors for better understanding of the research study at the initial screening? During screening 290 (55%) cases and 172 (33%) controls scored below the 14.5 cut-off for acceptable understanding of the research study elements, however after iterative learning only 38 (7%) cases and 13 (2.5%) controls continued to score below this cut-off. Significant variables associated with increased understanding of the consent included the psychiatric nurse recruiter conducting the consent screening, higher participant level of education, and being a control. The UBACC proved an effective tool to improve understanding of research study elements during consent, for both cases and controls. The tool holds utility for complex studies such as those involving genomics, where iterative learning can be used to make significant improvements in understanding of research study elements. The UBACC may be particularly important in groups with severe mental illness and lower education levels. Study recruiters play a significant role in managing the quality of the informed consent process.
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