ENTOMOPHAGY AS A POTENTIAL TOURISM PRODUCT: THE CASE OF THE MOPANI DISTRICT, LIMPOPO PROVINCE, SOUTH AFRICA

Malaria infects and kills millions of people in Africa, predominantly in hot regions where temperatures during the day and night are typically high. In South Africa, Limpopo Province is the hottest province in the country and therefore prone to malaria incidence. The districts of Vhembe, Mopani and Sekhukhune are the hottest districts in the province. Malaria cases in these districts are common and malaria is among the leading causes of illness and deaths in these districts. Factors contributing to malaria incidence in Limpopo Province have not been deeply investigated, aside from the general knowledge that the province is the hottest in South Africa. Bayesian and classical methods of estimation have been applied and compared on the effect of climatic factors on malaria incidence. Credible and confidence intervals from a negative binomial model estimated via Bayesian estimation and maximum likelihood estimation, respectively, were utilized in the comparison process. Overall assumptions underpinning each method were given. The Bayesian method appeared more robust than the classical method in analysing malaria incidence in Limpopo Province. The classical method identified rainfall and temperature during the night to be significant predictors of malaria incidence in Mopani, Vhembe and Waterberg districts. However, the Bayesian method found rainfall, normalised difference vegetation index, elevation, temperatures during the day and night to be the significant predictors of malaria incidence in Mopani, Sekhukhune and Vhembe districts of Limpopo Province. Both methods affirmed that Vhembe district is more susceptible to malaria incidence, followed by Mopani district. We recommend that the Department of Health and Malaria Control Programme of South Africa allocate more resources for malaria control, prevention and elimination to Vhembe and Mopani districts of Limpopo Province.

Introduction : South Africa (SA) has set a goal of malaria elimination by 2018. Malaria remains a major public health challenge in Vhembe and Mopani districts, Limpopo province-two of the five malaria endemic districts in SA. On 2 May 2017, health facilities in the two districts reported an unusual increase of malaria cases. Investigations were conducted to establish existence, magnitude and cause of the outbreak, to recommend control measures for the current outbreak and future prevention. Methods : a cross-sectional investigation was conducted. Discussions with key stakeholders were held. We reviewed malaria case data collected through the Limpopo provincial malaria information system from April to May 2017. We defined a case as a person with malaria confirmation by microscopy or a rapid diagnostic test (RDT) in health facilities of the two districts from April to May 2017. Results : a total of 5 662 cases, 55.3% in Mopani, were reported with a peak in May 2017.Investigation of likely origin revealed that 5 574 (98.4%) were local cases in both districts. Fifty-four malaria deaths were reported, majority 42 (77.8%) in Mopani district. The median age of the patients who died was 44 years (IQR 35-60) with 0.95% case fatality rate (CFR). 99.9% of all cases were Plasmodium Falciparum. Indoor residual spraying (IRS) coverage was less than WHO recommended 80% universal coverage for control. An environmental assessment revealed that 2016/17 season recorded higher levels of rainfall and temperature compared to previous malaria season. Key stakeholder interviews revealed that the outbreak in the province was associated with late commencement of IRS due to late appointment of spray teams; reduced use of Dichlorodiphenyltrichloroethane (DDT) which was replaced by pyrethroids (K-Othrine and Deltamethrine); and stock outs of RDTS and anti-malaria drugs in clinics. Conclusion : the investigation established that the marked increase in malaria cases in Vhembe and Mopani districts was not a seasonal phenomenon but rather an outbreak. We recommended a community awareness program through local radio stations on malaria prevention and treatment; improved supply chain of RDTs and antimalarial drugs to prevent stock outs; budget allocation for procurement of DDT and advance appointment of IRS teams.

ObjectivesRecently, we reported a high prevalence (16%) of urogenital Chlamydia trachomatis infections among women in a rural setting in South Africa. Molecular epidemiological studies on C. trachomatis infections could provide...

Many low- and middle-income countries face challenges in attaining adequate levels of vaccination coverage, and the factors driving this under-coverage have not been completely elucidated. In this cross-sectional study, we investigated factors associated with vaccination coverage in Mopani District, Limpopo Province, South Africa. Between July and October 2017, we surveyed 317 caregivers (83% of whom were mothers) of seven-month-old infants in Mopani District about barriers faced when attaining vaccines and attitudes towards vaccination, and reviewed the infants' documented vaccination history. Caregiver and child demographic data were collected shortly after birth. We described the coverage for vaccines that should be received by age seven months, according to South Africa's Expanded Programme on Immunization schedule, and explored the relationship between coverage and caregiver characteristics, behavioral factors (e.g. attitudes towards vaccination), and structural factors (e.g. vaccination stock-outs at clinics). We found that caregivers reported positive attitudes towards vaccination, based on a seven-question survey of vaccination attitudes. Although coverage was high for most recommended vaccines, it was low for pneumococcal conjugate vaccine (PCV), with just 36% of children having received it by age seven months. This appears to have been due to PCV stock-outs at government clinics. For vaccines other than PCV, children were more likely to be up-to-date on vaccinations if a community health worker (CHW) had visited their home in the past month (adjusted odds ratio (OR) 1.24, confidence interval (CI) (1.10-1.41); p < 0.001) and if the caregiver had more years of schooling (adjusted OR 1.03 (CI 1.01-1.05); p = 0.012). We conclude that addressing PCV stock-outs at government clinics in Mopani District is necessary to ensure coverage reaches adequate levels. Additionally, supporting CHW programs may be a productive avenue for improving vaccination coverage.

South Africa is a nation of diverse groups, each with its own characterised ethnicity, cultural heritage, language, history, and beliefs. The various public entities that make up the multicultural landscape of South Africa are marked by toponyms that allude to the above-mentioned characterising sociocultural aspects. Institutions of learning such as public schools are among the many entities which carry toponyms that are reflective of societal structures and shared community values. It is important to consider the historical background, and motivations behind the names of public schools in order to gain insight into the sociocultural factors and power relations at play. Therefore, the purpose of this paper was to explore the significance of public school names and their meanings at Ga-Sekororo. The study was conducted using a qualitative research approach in the interpretive paradigm, with a case study as the research design. Face-to-face semi-structured interviews were administered, with 12 participants that included 4 school principals, 4 community leaders, 2 regional circuit officials, and 2 of officials from the Departments of Education from Limpopo province, South Africa. The study’s findings revealed that the significance of public school names at Ga-Sekororo is to commemorate persons from royalty and preserve their identity and history. In addition, the data suggest that public school names denote land custodianship to tribal authorities and that the schools named after geographical features are helpful in linking the schools with the environment they are found at. It is recommended that the names of public schools should be expanded to include not only names of members of the royal council, but also names of individuals who have made significant contributions to the community. Names of public schools should draw inspiration from a memorable event in the community regardless of whether persons associated with the event are royalty or not.

Access to point-of-care (POC) diagnostics in resource-limited settings, where laboratory-based diagnostics are limited, depends on efficient supply chain management (SCM). This study evaluated the SCM for SARS-CoV-2 POC diagnostic services in resource-limited settings to determine the effect of SCM on accessibility to SARS-CoV-2 POC tests and to identify barriers and enablers of accessibility to SARS-CoV-2 diagnostic services in Mopani District, Limpopo Province, South Africa. We purposively assessed 47 clinics providing POC diagnostic services between June and September 2022. One participant per clinic completed an audit tool developed by the authors with guidance from the World Health Organization and the Management Sciences for Health guidelines. The audit tool evaluated the following SCM parameters: selection, quantification, storage, procurement, quality assurance, distribution, redistribution, inventory management, and human resource capacity. Percentage rating scores between 90-100% indicated that the facility was compliant with SCM guidelines, while rating scores < 90% indicated non-compliance. The clinic audit scores were summarized and compared across clinics and sub-districts. Clinics had compliance scores ranging from 60.5% to 89.2%. Compliance scores were the highest for procurement, redistribution, and quality assurance (all 100%), followed by storage (mean = 95.2%, 95% CI: 90.7-99.7), quantification (mean = 89.4%, 95% CI: 80.2-98.5), and selection (mean = 87.5%, 95% CI: 87.5%-87.5%). Compliance scores were the lowest for inventory management (mean = 53.2%, 95% CI: 47.9%-58.5%), distribution (mean = 48.6%, 95% CI: 44.6%-52.7%), and human resource capacity (mean = 50.6%, 95% CI: 43.3%-58.0%). A significant correlation was found between compliance score and clinic headcount (r = 0.4, p = 0.008), and compliance score and ideal clinic score (r = 0.4, p = 0.0003). Overall, the 47 clinics audited did not comply with international SCM guidelines. Of the nine SCM parameters evaluated, only procurement, redistribution, and quality assurance did not need improvement. All parameters are key in ensuring full functionality of SCM systems and equitable access to SARS-CoV-2 POC diagnostics in resource limited settings.

Background With a sustained national malaria incidence of fewer than one case per 1000 population at risk, in 2012 South Africa officially transitioned from controlling malaria to the ambitious goal of eliminating malaria within its borders by 2018. This review assesses the progress made in the 3 years since programme re-orientation while highlighting challenges and suggesting priorities for moving the malaria programme towards elimination.Methods National malaria case data and annual spray coverage data from 2010 until 2014 were assessed for trends. Information on surveillance, monitoring and evaluation systems, human and infrastructure needs and community malaria knowledge was sourced from the national programme mid-term review.ResultsMalaria cases increased markedly from 6811 in 2013 to 11,711 in 2014, with Mpumalanga and Limpopo provinces most affected. Enhanced local transmission appeared to drive malaria transmission in Limpopo Province, while imported malaria cases accounted for the majority of cases reported in Mpumalanga Province. Despite these increases only Vhembe and Mopani districts in Limpopo Province reported malaria incidences more than one case per 1000 population at risk by 2014. Over the review period annual spray coverage did not reach the recommended target of 90 % coverage, with information gaps identified in parasite prevalence, artemether-lumefantrine therapeutic utilization, asymptomatic/sub-patent carriage, drug efficacy, vector distribution and insecticide resistance.ConclusionsAlthough South Africa has made steady progress since adopting an elimination agenda, a number of challenges have been identified. The heterogeneity of malaria transmission suggests interventions in Vhembe and Mopani districts should focus on control, while in KwaZulu-Natal Province eliminating transmission foci should be prioritized. Cross-border initiatives with neighbouring countries should be established/strengthened as a matter of urgency since malaria importation poses a real threat to the country’s elimination efforts. It is also critical that provincial programmes are adequately resourced to effectively conduct the necessary targeted elimination activities, informed by current vector/parasite distribution and resistance data. More sensitive methods to detect sub-patent infections, primaquine as a transmission-blocking drug, and alternative vector control methods need to be investigated. Knowledge gaps among malaria health workers and affected communities should be identified and addressed.

ABSTRACTIntroductionAccess to healthcare facilities in rural areas remains a major challenge, particularly during the coronavirus disease 2019 (COVID‐19) pandemic. This study investigated the spatial distribution and accessibility of COVID‐19 point‐of‐care (POC) diagnostic services in Mopani District, Limpopo province, South Africa, using a geographic information system (GIS)‐based approach. The aim was to identify areas where healthcare access requires improvement.MethodsA descriptive cross‐sectional study design was used, analysing secondary data through dasymetric mapping to disaggregate and re‐aggregate population data into analytical units. Accessibility was measured by distances from residences to the nearest primary healthcare (PHC) clinics (<5 km) and from clinics to the nearest district hospitals (<30 km). Demographic and socio‐economic data from Statistics South Africa were included for context.ResultsMopani District had an estimated population of 1,202,916, with 942,801 (78.4%) residing within 5 km of a PHC clinic. The district had 105 clinics, each serving about 11,456 people, and 72 (68.6%) of these clinics were within 30 km of a district hospital. The district contained both densely and sparsely populated areas, with high unemployment and low‐income levels, particularly in rural regions. Limited public transport further constrained access. Ba‐Phalaborwa, Maruleng, Greater Tzaneen and Greater Letaba have relatively good access, whereas Greater Giyani faces significant challenges.DiscussionAlthough a majority of the population lived within 5 km of a clinic, notable gaps in accessibility remain. Improving transport infrastructure, using telemedicine and mobile health units, and implementing socio‐economic support strategies, such as subsidized transport, can enhance access. Addressing geographic and structural inequalities in healthcare distribution is critical to promoting equity and improving health outcomes in rural districts like Mopani.

Diarrhea contributes significantly to global morbidity and mortality. There is evidence that diarrhea prevalence is associated with ambient temperature. This study aimed to determine if there was an association between ambient temperature and diarrhea at a rural site in South Africa. Daily diarrheal hospital admissions (2007 to 2016) at two large district hospitals in Mopani district, Limpopo province were compared to average daily temperature and apparent temperature (Tapp, ‘real-feel’ temperature that combined temperature, relative humidity, and wind speed). Linear regression and threshold regression, age-stratified to participants ≤5 years and >5 years old, considered changes in daily admissions by unit °C increase in Tapp. Daily ranges in ambient temperature and Tapp were 2–42 °C and −5–34 °C, respectively. For every 1 °C increase in average daily temperature, there was a 6% increase in hospital admissions for diarrhea for individuals of all ages (95% CI: 0.04–0.08; p < 0.001) and a 4% increase in admissions for individuals older than 5 years (95% CI: 0.02–0.05; p < 0.001). A positive linear relationship between average daily Tapp and all daily diarrheal admissions for children ≤5 years old was not statistically significant (95% CI: −0.00–0.03; p = 0.107). Diarrhea is common in children ≤5 years old, however, is more likely triggered by factors other than temperature/Tapp, while it is likely associated with increased temperature in individuals >5 years old. We are limited by lack of data on confounders and effect modifiers, thus, our findings are exploratory. To fully quantify how temperature affects hospital admission counts for diarrhea, future studies should include socio-economic–demographic factors as well as WASH-related data such as personal hygiene practices and access to clean water.

BackgroundSub-Saharan Africa faces and is severely affected by many conflicts. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) threaten both the physical and financial well-being of individuals in struggling...

BackgroundGlobally, there is evidence that three micronutrients deficiencies are of public health concern among children. They are vitamin A, iodine and iron deficiencies. Communities particularly affected are those in situations where poverty, unemployment, civil unrest, war and exploitation remain endemic. Malnutrition is an impediment to productivity, economic growth and poverty eradication. It is estimated that 32% of the global burden would be removed by eliminating malnutrition, including micronutrients deficiencies.SettingThe study was carried out in NkowaNkowa township of Mopani District, Limpopo Province, South Africa.AimThe main objective was to determine the women’s knowledge on food fortification.MethodsThe study design was descriptive. The snowballing method was used to identify women of child-bearing age. Data were collected from 120 participants using a questionnaire. The questionnaire consisted of socio-demographic, general questions on women’s knowledge on food fortification. The questionnaire was administered by the researcher using the local language Xitsonga.ResultsThe findings of the study revealed that a majority of 204 (57.0%) of the participants were able to define food fortification correctly while 257 (72.0%) of the participants knew which foods are fortified as well as the benefits of a food fortification programme. The majority (252 [70.0%]) of the participants knew that maize meal is one of the food vehicle used for fortification in South Africa.ConclusionMost of the questions were answered correctly by more than 50.0% of the participants. The researcher deduced that the study participants are knowledgeable about food fortification based on the response given in relation to the programme.

Cardiovascular diseases (CVDs) have a high disease burden both globally and in South Africa. They have also been found to be temperature-sensitive globally. The association between temperature and CVD morbidity has previously been demonstrated, but little is known about it in South Africa. It is important to understand how changes in temperature in South Africa will affect CVD morbidity, especially in rural regions, to inform public health interventions and adaptation strategies. This study aimed to determine the short-term effect of apparent temperature (Tapp) on CVD hospital admissions in Mopani District, Limpopo province, South Africa. A total of 3124 CVD hospital admissions records were obtained from two hospitals from 1 June 2009 to 31 December 2016. Daily Tapp was calculated using nearby weather station measurements. The association was modelled using a distributed lag non-linear model with a negative binomial regression over a 21-day lag period. The fraction of morbidity attributable to non-optimal Tapp, i.e., cold (6-25 °C) and warm (27-32 °C) Tapp was reported. We found an increase in the proportion of admissions due to CVDs for warm and cold Tapp cumulatively over 21 days. Increasing CVD admissions due to warm Tapp appeared immediately and lasted for two to four days, whereas the lag-structure for the cold effect was inconsistent. A proportion of 8.5% (95% Confidence Interval (CI): 3.1%, 13.7%) and 1.1% (95% CI: -1.4%, 3.5%) of the total CVD admissions was attributable to cold and warm temperatures, respectively. Warm and cold Tapp may increase CVD admissions, suggesting that the healthcare system and community need to be prepared in the context of global temperature changes.

BackgroundTeenage pregnancy is a global social health concern especially because of the HIV and AIDS pandemic, sexually transmitted infections, high rate of termination of pregnancy (TOP), adolescents’ parenthood and decreased level of contraceptives.AimTo explore the views of teenagers on the TOP at Muyexe high school in a rural village of Mopani District, Limpopo Province.SettingMuyexe high school in a rural village of Mopani District, Limpopo Province, in South Africa.MethodologyA qualitative method using explorative and descriptive designs was used to find in-depth description and understanding of teenagers’ views on TOP. The target population was girls aged 15–19 years at Muyexe high school in Mopani District. Non-probability, convenient sampling was used to select high school teenage girls who had undergone TOP for the study. Data were collected using individual self-report technique (interview). Tesch’s eight steps of qualitative data analysis were used. Measures to ensure trustworthiness and ethical considerations were observed.ResultsTwo major themes were revealed: (1) Views of teenagers regarding TOP (poverty, relationship problems and single parenthood, negative impact on the teen’s life while attending school) and (2) teenager’s fears regarding pregnancy (stigma, fear of parents and friends, rape and incest and fear of giving birth).ConclusionMajority of participants had knowledge about TOP; some had experiences about TOP while others held inadequate knowledge. Recommendations were based on the findings by teaching dangers of TOP and various contraceptive methods to prevent unwanted pregnancies and TOP.

Effective supply chain management (SCM) of point-of-care (POC) tests for diseases like severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) requires active participation from diverse stakeholders, government entities, and regulatory bodies. The responsibility for overseeing various aspects of POC tests, including procurement, quality assurance, storage, inventory management, distribution, and human resource capacity, lies with national, provincial, and local levels of government. This study aimed to collaboratively develop an innovative approach to enhance SCM for SARS-CoV-2 POC diagnostic services in resource-limited settings, using the Mopani District in Limpopo province, South Africa, as a case study. Key stakeholders were invited to participate in an online workshop using purposive sampling. The study employed the nominal group technique (NGT) for data collection, which consisted of two phases. Phase 1 focused on identifying barriers in the supply chain of COVID-19 rapid tests, while phase 2 aimed to devise strategies to overcome the priority barriers identified in phase 1. Participants used a Likert scale of 1-5 to rank barriers and strategies, and an overall ranking score was calculated for each. The participants were provided with the results of the ranking exercise for their feedback. Eleven key stakeholders from national (n = 1), provincial (n = 4), and local government (n = 2) levels, research entities (n = 3), and non-governmental organizations (n = 1) took part in the study. Participants identified significant barriers in the supply chain, such as the availability of testing kits, unknown demand, information on SCM during a pandemic, methods of controlling stock, and procurement processes. Strategies suggested by key stakeholders included monitoring stock levels and optimizing stock visibility systems to improve test availability, enhancing information visibility and consistent data updates to address unknown demand and improve SCM during a pandemic, employing data capturing and digitization for effective stock control, and implementing demand planning and standardized procurement processes at the national level to enhance stock procurement. The successful collaboration with key stakeholders, facilitated by the NGT, resulted in the co-creation of a novel approach to enhance SCM for COVID-19 diagnostic services in resource-limited settings. This study holds the potential to support the provision of COVID-19 diagnostic services in such settings. A recommended follow-up study would assess the feasibility of implementing this approach.

BackgroundDiabetes mellitus (DM) is a common systemic disease amongst Black South Africans. It may lead to diabetic retinopathy (DR), a common cause of visual impairment (VI) and blindness. DR may significantly increase the prevalence of VI and blindness.AimTo assess risk factors for VI and blindness amongst a black diabetic South African population aged ≥ 40 years.SettingThe study was conducted in seven Government healthcare facilities (two hospitals, four clinics and one health centre) in Mopani District, Limpopo province, South Africa.MethodsThis was a cross-sectional health facility-based quantitative study. Structured interviews were used to obtain information, which included sociodemographic profile, knowledge about DM and its ocular complications, presence of hypertension and accessibility to health facilities. Subsequently participants were examined for VI and blindness using an autorefractor, pinhole disc, ophthalmoscope and logMAR visual acuity chart. Anthropometric measurements (height, weight and waist) were also taken. Associations between 31 risk factors and VI as well as blindness were statistically examined.ResultsParticipants (N = 225) included 161 women and 64 men aged 40–90 years (mean 61.5 ± 10.49 years); 41.3% of them had VI and 3.6% were blind. Cataracts (76.8%) and DR (7.1%) were the common causes of compensated VI and blindness. Risk factors that were associated with VI and blindness were age, monthly income, compliance with losing weight and physical activity.ConclusionFindings suggest that lifestyle intervention and appropriate eyecare programmes may reduce VI and blindness in this population.