African Programme Research Articles

A Fieldwork Forum for the VAF

A Fieldwork Forum for the VAF Brent R. Fortenberry and James Michael Buckley Fieldwork—the recording of buildings in situ with measured drawings and photographs—is one of the distinguishing features of vernacular architecture as a field of study. —Thomas Carter and Elizabeth Collins Cromley As Tom Carter and Betsy Cromley emphasize in their Invitation to Vernacular Architecture, the foundational introductory text for our field, fieldwork is central to the work of the Vernacular Architecture Forum. At the 2021 VAF Virtual Conference, we convened a group of VAF members for a plenary session called “Fieldwork Futures” that considered how our work in the field is evolving as intellectual, social, and technological conditions change around us. This panel led to a wide-ranging discussion among all those assembled about what the future of vernacular fieldwork might look like.1 After that session, we asked our panelists to follow up with a round of written commentary for this issue of Buildings & Landscapes, and we are delighted with the result. These articles allow the panelists room to expand on points they made during the session and to issue new challenges to our field in the twenty-first century. All of these authors ask about the meaning and relevance of vernacular fieldwork in the contemporary world and offer suggestions about how our field should carry out its mission to explore the ordinary built environment. Danielle Willkens discusses the opportunities and challenges of digital measurement techniques and demonstrates that there is as much craft involved with these technologies as there is with handheld tape measures and mechanical pencils. Elaine B. Stiles explores how preserving vernacular architecture will require “a fieldwork model that starts with people rather than material and received histories” in order to record for “a more representative, equitable, and just public history landscape” than we have achieved in the past. The role of oral history and ethnography involving living communities is the subject of Sarah Lopez’s reflection on interacting with Mexican migrants, and she offers some insights about how vernacular architecture fieldwork can enlarge the historical record with new types of evidence gleaned from those who presently make use of ordinary spaces. Arijit Sen challenges us to consider going beyond the physical recording of buildings by working with local communities toward social justice and by remaining open to the “serendipity” we always find out in the field. As we begin the exciting Mellon-funded VAF/ University of Virginia African American fieldwork program this summer, we will have the opportunity to test all of these methods of updating our fieldwork practice. We hope that by continuing our conversation at last year’s conference, this set of essays will help us keep thinking about our fieldwork in future issues of B&L, in conference sessions, and, of course, on long tour bus rides. notes 1. Thomas Carter and Elizabeth Collins Cromley, Invitation to Vernacular Architecture: A Guide to the Study of Ordinary Buildings and Landscapes (University of Tennessee Press, 2005), xvi. Copyright © 2022 Vernacular Architecture Forum

Biography and Bernard Bailyn: The Ordeal of Thomas Hutchinson and the “Logical Obligation” of Historical Research

Biography and Bernard Bailyn: <i>The Ordeal of Thomas Hutchinson</i> and the “Logical Obligation” of Historical Research

Introduction: Black Laughs Matter

Introduction: Black Laughs Matter

Witness Protection Programmes: The Role of Social Workers in Helping State Witnesses to Deal with Challenges

Admission of witnesses to the witness protection programme is necessary to protect their lives to ensure successful prosecutions. However, it poses serious challenges that result in the interruption of the functioning of a family such as social uprooting and isolation. There seems to be a shortage of literature on the protection of witnesses that focuses on their challenges and the support interventions they require to be able to adjust and cope in the programme. A qualitative research approach was followed to gain an in-depth understanding of the experiences of witnesses and the role of social workers in the South African witness protection programme. Non-probability, purposive sampling was used to select 30 participants, including witnesses, social workers and others. The findings describe the participants’ lack of knowledge and awareness of the existence of the witness protection programme, their experiences of trauma, and their difficulties to access social work services. The findings also describe the shortage of social workers to provide support and the unsatisfactory reintegration and aftercare services. This article facilitates insight into the world of witnesses who live in the witness protection programme. It highlights the essential role that social workers can play to help them work through existing trauma, adjust and cope in the programme, and reintegrate into the community.

Developing an African medical and health professions student regional elective exchange program: approaches and lessons learned

Background: Given the significant gap in International Medical Elective (IME) opportunities for African health professions students, the Educational Commission for Foreign Medical Graduates and the Foundation for Advancement of International Medical Education and Research (ECFMG|FAIMER) launched an African regional elective exchange program through the Global Educational Exchange in Medicine and the Health Professions (GEMx) in 2016. This paper provides an overview of the development of the GEMx program, the pillars of successful implementation, and lessons learned. Methods: The authors conducted a longitudinal qualitative study utilizing in-depth interviews with institutional leaders, Program leaders, and faculty, participant observation through symposia, strategic planning meetings, staff meetings, and document review of the annual progress reports, strategic plans, and newsletter articles, abstracts and concept notes. Common categories were identified and incorporated into a matrix to create themes. Data were analyzed using the manifest content approach guided by a literature review. Results: The key pillars for the successful implementation of the GEMx Africa regional elective exchange program included: the commitment from African training institutional networks and their member institutions that enabled electives to happen, the GEMx Charter (multilateral agreement) that enabled reciprocity and diversity of elective opportunities, GEMx web-based application system that enabled the centralization of the application process and real-time feedback on acceptance, GEMx Africa Regional Coordination Center in Kampala, Uganda that lead the development and implementation in Africa, and ECFMG mini-grants that help defray the biggest part of the elective costs. Conclusions: Through the development of successful partnerships across the continent, the GEMx regional elective exchange program contributed towards bridging a long-existing gap of inadequate opportunities for African health professions students to enhance their global exposure and strengthen their knowledge and skills.

Social-ecological change: insights from the Southern African Program on Ecosystem Change and Society

ABSTRACT Social-ecological systems (SES) research has emerged as an important area of sustainability science, informing and supporting pressing issues of transformation towards more sustainable, just and equitable futures. To date, much SES research has been done in or from the Global North, where the challenges and contexts for supporting sustainability transformations are substantially different from the Global South. This paper synthesises emerging insights on SES dynamics that can inform actions and advance research to support sustainability transformations specifically in the southern African context. The paper draws on work linked to members of the Southern African Program on Ecosystem Change and Society (SAPECS), a leading SES research network in the region, synthesizing key insights with respect to the five core themes of SAPECS: (i) transdisciplinary and engaged research, (ii) ecosystem services and human well-being, (iii) governance institutions and management practices, (iv) spatial relationships and cross-scale connections, and (v) regime shifts, traps and transformations. For each theme, we focus on insights that are particularly novel, interesting or important in the southern African context, and reflect on key research gaps and emerging frontiers for SES research in the region going forward. Such place-based insights are important for understanding the variation in SES dynamics around the world, and are crucial for informing a context-sensitive global agenda to foster sustainability transformations at local to global scales.

Estimation of Genetic Parameters for Heifer and Cow Fertility Traits Derived from On-Farm AI Service Records of South African Holstein Cattle.

Simple SummaryFemale fertility has gained significant attention and is incorporated in dairy cattle breeding objectives worldwide. Currently, age at first calving (AFC) and calving interval (CI) are the only traits used as indicators of fertility in the genetic evaluations of South African dairy cattle, but these traits are greatly affected by the breeder’s decisions and calving interval is available late in an animal’s life which delays selection decisions. This study investigated the possible use of additional fertility traits derived from artificial insemination records. The fertility traits examined in this study could be used in addition to age at first calving and calving interval to select for improved fertility in dairy cattle.This study aimed to derive additional fertility traits from service data and estimate their genetic parameters for their possible inclusion in the South African Holstein cattle breeding programs. Service records (n = 64,464) were collected from 18 South African Holstein herds using on-farm automated milk recording systems. Using a multivariate model, the data were used to estimate heritabilities and correlations among several fertility traits. The pedigree data consisted of information on 18,592 animals born between 1981 and 2013. Heritability estimates observed were low to moderate (0.02 ± 0.00 to 0.24 ± 0.00), indicating that there is some genetic basis for the explored fertility traits to warrant selection. The genetic correlations observed between fertility traits were generally favorable, with some high correlations between age at first service (AFS) and services per conception for heifers (SPCh) (0.73 ± 0.00) and between days from calving to first service (CFS) and services per conception for cows (SPC) (0.90 ± 0.01). Positive genetic correlations indicate that improvement in one trait is coupled with a correlated genetic increase in another trait. The studied fertility traits could be used in addition to AFC and CI to serve as a basis for the selection of reproduction in dairy cattle to minimize selection bias.

Students’ experiences of the value of lectures for their learning: a close-up comparative study across four institutions

ABSTRACT There is limited contemporary evidence around students’ experience of lectures, notwithstanding critiques of their value. This study focuses on second-year chemical engineering students across four institutions in England and South Africa. The analysis of student interviews identified three themes describing what students value in lectures. In terms of interaction, they valued simply being able to ask questions. In terms of explanations, pacing was key and working through problems by hand was valued, while the use of powerpoint often received critique. The final theme shows how resources form a crucial link from the lecture into students’ private studying. This study also drew on lecturer interviews, and the comparison shows considerable coherence between lecturer intentions and students' experiences. The final aspect of this study compared across institutions, and here we see the structural impact of the high levels of contact time in the South African programmes.

Dietary Diversity and its Association with Nutritional Status, Cardiometabolic Risk Factors and Food Choices of Adults at Risk for Type 2 Diabetes Mellitus in Cape Town, South Africa.

In South Africa, the nutrition transition has led to unhealthy diets lacking variety, contributing to the rise in overweight, obesity and diet-related noncommunicable diseases. Using baseline screening data of the South African Diabetes Prevention Programme (SA-DPP) study, this study aims to determine the relationship of dietary diversity (DD) with nutritional status, cardiometabolic risk factors and food choices of adults at risk of type 2 diabetes in resource-poor communities around Cape Town. Data of 693 adults, 25–65 years old were analysed. This included socio-demographic information, anthropometric measurements, biochemical assessments, food groups consumed the previous day and consumption frequency of certain foods to reflect food choices. The Minimum Dietary Diversity for Women (MDD-W) indicator was calculated; 70.4% of participants had low DD (<5 food groups). Low DD was associated with elevated serum triglycerides [AOR: 1.49, 95% CI (1.03, 2.15) p = 0.036]. The DD score was positively correlated (although weak) with the unhealthy food score (r = 0.191, p = 0.050) and sugary food score (r = 0.139, p < 0.01). Study participants at risk of diabetes consumed a diet low in DD; however, DD was not associated with nutritional status or cardiometabolic risk factors except for serum triglycerides.

Evaluation of the effectiveness of a South African laboratory cryptococcal antigen screening programme using a retrospective cohort and a cluster-randomised trial design

IntroductionCryptococcal meningitis is a common fungal opportunistic infection and a leading cause of death among people with advanced HIV disease in sub-Saharan Africa. The WHO recommends cryptococcal antigen (CrAg) screening...

How to plan for simulation integration into undergraduate physiotherapy training

Background. The benefits of simulation in healthcare education are undeniable, and in the current healthcare climate, a drastic change in delivering healthcare training is critical. Therefore, integration of simulation is essential, and necessitates detailed planning and well-trained educators. Objectives. To develop a conceptual framework for the integration of simulation in South African (SA) undergraduate physiotherapy programmes. Methods. A non-experimental descriptive research design using a modified Delphi survey was conducted. Results from a systematic review identifying simulation integration framework elements informed the Delphi survey. A purposive sample of 15 healthcare educationalists from SA and abroad were approached to participate. Data were analysed as percentages, and feedback was provided to panel members following each round.&#x0D; Results. A response rate of 73.3% (n=11) was achieved. Planning was explored as one of the themes. Both institutional- and discipline-specific needs analyses were identified as essential (93%), and societal needs were useful to consider (64%). Resource identification and sharing (84%) were regarded as vital, and expert collaboration in curriculum development (79%) with scaffolded skills integration (75%) was advised. The necessity for trained facilitators (93%) and educator role identification (71%) was evident. Statements related to mastery learning/deliberate practice and the use of simulation for assessment purposes yielded the least consensus.&#x0D; Conclusion. A constructively aligned curriculum based on both student and institutional needs and resource availability in guiding simulation integration was regarded as essential. Educator competency in both the development and delivery of the programme, especially debriefing methods, is vital for optimising student learning.

Building research capacity in an under‐represented group: The STAARS program experience

AbstractFor decades, the lack of high‐quality empirical economic research on the state of Africa's agriculture and rural economies has been an important factor impeding the formulation of evidence‐based policy on the continent. The Structural Transformation of African Agriculture and Rural Spaces program aims to build a critical mass of early career African scholars and policy research through an emphasis on mentorship and professional development to help remedy that deficiency. This paper explains the motivations, origins, and outcomes to date of the program, and offers lessons learned for others wishing to create research capacity development opportunities for under‐represented groups.

Genomic consequences of artificial selection during early domestication of a wood fibre crop.

Summary From its origins in Australia, Eucalyptus grandis has spread to every continent, except Antarctica, as a wood crop. It has been cultivated and bred for over 100 yr in places such as South Africa. Unlike most annual crops and fruit trees, domestication of E. grandis is still in its infancy, representing a unique opportunity to interrogate the genomic consequences of artificial selection early in the domestication process.To determine how a century of artificial selection has changed the genome of E. grandis, we generated single nucleotide polymorphism genotypes for 1080 individuals from three advanced South African breeding programmes using the EUChip60K chip, and investigated population structure and genome‐wide differentiation patterns relative to wild progenitors.Breeding and wild populations appeared genetically distinct. We found genomic evidence of evolutionary processes known to have occurred in other plant domesticates, including interspecific introgression and intraspecific infusion from wild material. Furthermore, we found genomic regions with increased linkage disequilibrium and genetic differentiation, putatively representing early soft sweeps of selection.This is, to our knowledge, the first study of genomic signatures of domestication in a timber species looking beyond the first few generations of cultivation. Our findings highlight the importance of intra‐ and interspecific hybridization during early domestication.

CHAPTER 7: Reflecting on Four South African Case Studies of Experiential Learning in Spatial Planning to Inform Curriculum Transformation in Higher Education.

Reflections on the application of experiential learning cases in South African spatial planning programs remain rare in existing scholarship and warrant further research. Critical thinking and experiential learning are prerequisites to accredit South African curricula of spatial planning education by its professional body, the South African Council for Planners. In African contexts, approaches to spatial planning education have been highly influenced by the logic, systems, and skills of colonial-era town planning. The main argument in this chapter is that students studying in the field of spatial planning may benefit from learning through experiences with real-life situations (case studies), as these generate context-specific forms of knowledge, providing possible strategies of action and intervention in conditions of high complexity, which invariably characterise urban development problems in Africa. The concept ‘learning’ in this chapter is viewed from a critical social constructivist perspective as it is a social epistemology that is important for the socio-cultural context of knowledge construction, especially evident in our country. This chapter follows a collaborative reflection methodology where four cases of experiential learning (2018-2020) in spatial planning education have been reflected upon during a reflective lecturer’s retreat in August 2021. The reflection was conducted in four stages, namely clarification, exploration, focalisation and interpretation. The cases include four spatial planning modules from three different year levels, focussing on different socio-spatial South African higher education contexts. The main findings that have emerged from the collaborative reflection, include that the application of experiential learning in the education of students studying spatial planning is not only beneficial to the students, but also contribute immensely towards the development of the lecturers, planning the curriculum and eventually the practice of interpreting planning practice for the purposes of teaching and learning. The study illustrates the potential of experiential learning to promote a reflective approach to learning, while fostering skill development in complex problem-solving with contemporary relevance in the field of spatial planning.

Outcomes of flucytosine-containing combination treatment for cryptococcal meningitis in a South African national access programme: a cross-sectional observational study

Although flucytosine is a key component of WHO-recommended induction treatment for HIV-associated cryptococcal meningitis, this antifungal agent is not widely available in low-income and middle-income countries due to limited production and cost. In 2018, a national flucytosine access programme was initiated in South Africa. We aimed to determine the effectiveness of flucytosine-containing induction regimens in routine care to motivate for the urgent registration of flucytosine and its inclusion in treatment guidelines. In this cross-sectional study, we compared outcomes of adults aged 18 years and older with incident laboratory-confirmed cryptococcal meningitis treated with or without flucytosine-containing regimens at 19 sentinel hospitals in South Africa. A case of cryptococcosis was defined as illness in an adult with: (1) positive cerebrospinal fluid (CSF) India ink microscopy; (2) a positive CSF cryptococcal antigen test; or (3) culture of Cryptococcus neoformans or Cryptococcus gattii from CSF or any other specimen. We excluded patients without a case report form, those with an unknown or negative HIV serology result, those with a recurrent episode, and those who did not receive antifungal treatment in hospital. We assessed cumulative in-hospital mortality at 14 days and 30 days and calculated the overall crude in-hospital case-fatality ratio. We used random-effects logistic regression to examine the association between treatment group and in-hospital mortality. From July 1, 2018, to March 31, 2020, 10 668 individuals were diagnosed with laboratory-confirmed cryptococcal meningitis, 7787 cases diagnosed at non-enhanced surveillance sites and 567 cases from eight enhanced surveillance sites with no access to flucytosine were excluded. Of 2314 adults with a first episode of cryptococcosis diagnosed at 19 facilities with access to flucytosine, 1996 had a case report form and of these, 1539 received induction antifungal treatment and were confirmed HIV-seropositive first-episode cases. Of 1539 patients who received antifungal therapy, 596 (38·7%) individuals received a flucytosine-containing regimen and 943 (61·3%) received another regimen. The median age was 36 years (IQR 32-43) and 906 (58·9%) participants were male and 633 (41·1%) were female. The crude in-hospital case-fatality ratio was 23·9% (95% CI 20·0-27·0; 143 of 596) in those treated with flucytosine-containing regimens and 37·2% (95% CI 34·0-40·0; 351 of 943) in those treated with other regimens. Patients admitted to non-academic hospitals (adjusted odds ratio [aOR] 1·95 [95% CI 1·53-2·48]; p<0·0001) and those who were antiretroviral treatment-experienced (aOR 1·30 [1·02-1·67]; p=0·033) were more likely to receive flucytosine. After adjusting for relevant confounders, flucytosine treatment was associated with a 53% reduction in mortality (aOR 0·47 [95% CI 0·35-0·64]; p<0·0001). Among survivors, the median length of hospital admission in the flucytosine group was 11 days (IQR 8-15) versus 17 days (13-21) in the comparison group (p=0·0010). In-hospital mortality among patients treated with a flucytosine-containing regimen was comparable to reduced mortality reported in patients receiving a flucytosine-containing regimen in a recent multicentre African clinical trial. Flucytosine-based treatment can be delivered in routine care in a middle-income country with a substantial survival benefit. National Institute for Communicable Diseases, a Division of the National Health Laboratory Service. For the Zulu translation of the abstract see Supplementary Materials section.

Access to flucytosine for the treatment of HIV-associated cryptococcal meningitis in Africa

Cryptococcal meningitis, a major cause of meningitis in adults living with HIV infection, accounts for 15% of global HIV-associated mortality. 1 Rajasingham R Smith RM Park BJ et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis. 2017; 17: 873-881 Summary Full Text Full Text PDF PubMed Scopus (973) Google Scholar Treatment of cryptococcal meningitis involves three phases: induction, consolidation, and maintenance. The induction phase, which aims at reducing cerebral and meningeal fungal burden crucial for early survival, requires combination antifungal therapy and management of increased cerebrospinal fluid intracranial pressure. WHO in 2018 recommended at induction either 1-week amphotericin B deoxycholate plus flucytosine followed by high-dose fluconazole or 2-week oral fluconazole plus flucytosine. 2 WHOGuidelines for the diagnosis, prevention, and management of cryptococcal disease in HIV-infected adults, adolescents and children. Supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. https://www.who.int/publications/i/item/9789241550277Date: 2018 Date accessed: April 14, 2022 Google Scholar However, in the absence of flucytosine, fluconazole plus amphotericin B deoxycholate could be an alternative. The Advancing Cryptococcal Meningitis treatment for Africa trial on which these recommendations were based showed flucytosine to be a better drug at reducing mortality than is fluconazole in combination with amphotericin B deoxycholate. 3 Molloy SF Kanyama C Heyderman RS et al. Antifungal combinations for treatment of cryptococcal meningitis in Africa. N Engl J Med. 2018; 378: 1004-1017 Crossref PubMed Scopus (176) Google Scholar In a recent trial, a combination of single dose 10 mg/kg liposomal amphotericin B and 2-week flucytosine plus fluconazole showed non-inferiority and tolerance benefits to previously recommended induction therapy. 4 Jarvis JN Lawrence DS Meya DB et al. Single-dose liposomal amphotericin B treatment for cryptococcal meningitis. N Engl J Med. 2022; 386: 1109-1120 Crossref PubMed Scopus (9) Google Scholar These trials and some observational studies 5 Dromer F Mathoulin-Pelissier S Launay O Lortholary O French Cryptococcosis Study GDeterminants of disease presentation and outcome during cryptococcosis: the CryptoA/D study. PLoS Med. 2007; 4: e21 Crossref PubMed Scopus (280) Google Scholar provide data that confirm flucytosine as an important drug combination for inductive treatment of cryptococcal meningitis. However, access to this old, off patent drug is not guaranteed in Africa, South America, and Asia where the burden of cryptococcal meningitis is highest. 6 Loyse A Dromer F Day J Lortholary O Harrison TS Flucytosine and cryptococcosis: time to urgently address the worldwide accessibility of a 50-year-old antifungal. J Antimicrob Chemother. 2013; 68: 2435-2444 Crossref PubMed Scopus (83) Google Scholar In South Africa, a region with a long-standing high burden of cryptococcal meningitis, flucytosine was only registered in December, 2021, by the South African Health Products Regulatory Authority (SAHPRA) despite the application being submitted 2 years previously by Viatris. 7 Application for WHO Model List of Essential Medicines: flucytosine (5FC). http://www.life-worldwide.org/assets/uploads/files/Flucytosine_63_CORE_AC.pdfDate: 2018 Date accessed: April 24, 2022 Google Scholar Outcomes of flucytosine-containing combination treatment for cryptococcal meningitis in a South African national access programme: a cross-sectional observational studyIn-hospital mortality among patients treated with a flucytosine-containing regimen was comparable to reduced mortality reported in patients receiving a flucytosine-containing regimen in a recent multicentre African clinical trial. Flucytosine-based treatment can be delivered in routine care in a middle-income country with a substantial survival benefit. Full-Text PDF

A collaborative model for continuing medical education: Impact of a distance learning curriculum for existing radiation oncology centers in Africa and Latin America.

11007 Background: We aimed to evaluate the outcomes and generalizability of a distance learning curriculum on intensity modulated radiotherapy (IMRT), a course developed for radiotherapy clinics across Africa and Latin America (LATAM) at no cost, as measured by a knowledge-based multiple-choice exam, learner self-evaluation, and open-ended feedback. Methods: Following needs identification studies, a curriculum entitled “IMRT 2.0” was created for an audience that included medical physicists, radiation oncologists, radiation therapists, and trainees. Volunteer educators delivered 27 hour-long sessions 1-2 times weekly for four months using video conferencing to African and LATAM programs in English and Spanish, respectively. Recordings and educational materials were shared following each session. Pre- and post-course multiple choice examinations were administered to LATAM participants, and pre- and post-course Likert scale self-evaluation and open-ended feedback were collected for both programs. Paired sample t-tests and chi-squared tests were performed for all available paired quantitative and categorical data, respectively. Pearson correlation coefficient, multivariate linear regression, and spline regression models were used to explore impact of course attendance on outcomes. Results: 25 centers across Africa (12 + 1 sister institution in Pakistan) and LATAM (12) were recruited, the majority (92%) of which were recently transitioning or planning to transition to IMRT, yielding a total of 332 enrolled participants. 27 sessions were delivered with a mean of 44 (std dev 22.5) and 85 (std dev 25.4) participants per session for the African and LATAM programs, respectively. Paired pre- and post-course data demonstrated significant improvement in both knowledge (n = 51, p &lt;.001) and overall self-confidence (n = 85, p &lt;.001). Synchronous participation did not predict greater score improvement or increase in self-confidence. Thematic analysis suggests that participants found great value in this course and look forward to future learning. Conclusions: A volunteer-driven course on IMRT is generalizable across regions in different languages and serves as an effective hub to arm participating centers with the knowledge and confidence they need to enhance patient care at their institutions. This benefit may propagate as participants become the next generation of trainers. Other fields and specialties aiming to reduce global health care disparities through training efforts could consider adopting this approach.

APPLICABILITY OF THE SOUTH AFRICAN DIABETES PREVENTION PROGRAMME IN THE EASTERN CAPE PROVINCE OF SOUTH AFRICA: A STUDY PROTOCOL

Objective: South Africa (SA) is currently home to almost 14% of the estimated 19 million people living with diabetes in Sub-Saharan Africa (SSA). Urgent efforts are needed both to diagnose and appropriately manage South Africans with diabetes, as well as to prevent the progression to diabetes among those at high risk. While, there is definitive evidence on the effectiveness of lifestyle interventions in preventing the progression of diabetes among high risk people in high income countries, little is known about appropriate intervention approaches to be used in SA (within all nine provinces) and other SSA countries. The South African Diabetes Prevention Programme (SA-DPP) was initiated to generate such evidence for SA and inform similar initiatives in other countries in the region. The goal of the SA-DPP is to prevent or delay the occurrence of diabetes among high risk South Africans, with benefits extending to other major cardiometabolic risk factors that share behavioural determinants with T2DM. The purpose of this project is to implement and evaluate the suitability and applicability of the SA-DPP developed and tailored in urban populations in the Western Cape Province, in peri-urban populations in the Eastern Cape Province of South Africa. Design and method: We propose to implement and evaluate a DPP that has been adapted for SA, which was based on interventions previously shown to be effective in Finland and Australia. The SA-DPP trial is in its intermediate phases in Cape Town. We will use an open-labelled cluster randomized control design, with optional implementation of the intervention in the control clusters at the end of the study. 24 clusters across peri-urban communities in OR Tambo, Eastern Cape will be randomly allocated to participate in a lifestyle intervention facilitated by teams of non-professional health workers. Results: NA. Conclusions: Programme success will be assessed by comparing at 12-months participants in clusters receiving the intervention and those in the clusters not yet receiving the intervention for changes in: 1) body weight; 2) blood glucose, lipids, blood pressure, insulin sensitivity, diabetes risk score, albuminuria; 3) and incident diabetes; 4) safety and participant satisfaction. 4) Economic impact.

Diagnostic performance of dobutamine stress echocardiography: A South African experience

Background. Dobutamine stress echocardiography (DSE) is a well-established modality for the diagnosis of coronary artery disease, but there are no reported diagnostic data in southern Africa. Objectives. To compare the safety, sensitivity and specificity of a South African (SA) DSE programme with larger, international series. Methods. All patients undergoing DSE from 2019 to 2021 at a single SA centre were included. A new wall motion abnormality (≥2 segments) signified inducible ischaemia. Results. A total of 106 patients (mean (standard deviation) age 61 (11) years, 68% male) were analysed. Six patients (6%) experienced chest pain during DSE and 4 (4%) developed an atrial arrhythmia. The sensitivity and specificity for epicardial coronary stenosis were 77% and 74%, respectively, changing to 82% and 72% when excluding those who had previous coronary artery bypass surgery. Conclusion. The sensitivity, specificity and safety of an SA DSE programme were comparable to international series. A DSE programme is feasible in a resource-constrained environment.

DETECTING CHRONIC KIDNEY DISEASE BY LEVERAGING SCREENING INITIATIVES FOR OTHER NON-COMMUNICABLE DISEASES

Objective: Early diagnosis of chronic kidney disease (CKD) slows disease progression and reduces mortality; yet screening for CKD is sparse in clinical practice. Contrary, screening for CKD risk factors like hypertension and type 2 diabetes mellitus (T2DM) are included in clinical practice guidelines in most countries. Therefore, an opportunity exists to implement CKD screening as a by-product of these existing screening programmes. To evaluate the viability of CKD screening, we used the South African Diabetes Prevention Programme (SA-DPP) to assess the yield of CKD cases. Design and method: The SA-DPP was conducted across 16 resource-poor communities in Cape Town, South Africa, between 2017 and 2019. Participants, aged 25–65 years, were recruited by random and self-selected sampling techniques. The African diabetes risk score (ADRS), which is a screening tool comprising non-laboratory-based variables including age, waist circumference and the presence of hypertension, was used to identify adults at high risk for T2DM. Those at high-risk were invited for confirmatory oral glucose tolerance test (OGTT). Kidney function was estimated using the serum creatinine-based CKD Epidemiology Collaboration equation. CKD was defined as an estimated glomerular filtration rate (eGFR) of &lt; 90 ml/min/1.73 m2 and/or albumin-to-creatinine ratio &gt; 3 mg/mmol. Results: Of the 2039 individuals screened in the community, 690 participants deemed at high-risk of T2DM presented at the research clinic for an OGTT. Of these individuals, 9.6% (n = 66) had diabetes and 18.1% (n = 125) had CKD, with 2.2% (n = 15) presenting with both CKD and T2DM. Most CKD cases were in the early stages of the disease, with 73.6% (n = 92), 17.6% (n = 22) and 7.2% (n = 9) presenting with stage 1–3, respectively. Of those with CKD stages 1–3, 72.8%, 68.2% and 44.5% had microalbuminuria, respectively with 27.2%, 31.8% and 11.1% presenting with macroalbuminuria. Most participants with early-stage CKD were overweight/obese (95.1%) and 47.0% had hypertension. Conclusions: By including markers of kidney function into the scope of markers collected in an existing disease screening programme, we were able to detect a great proportion of CKD cases. Therefore, by utilizing an opportunistic approach, people with early-stage CKD can be identified and appropriately treated.