North West Province Research Articles

Kidney dysfunction: prevalence and associated risk factors in a community-based study from the North West Province of South Africa

BackgroundGlobally, the World Health Organization ranks chronic kidney disease (CKD) as one of the top 10 causes of mortality. In South Africa, where noncommunicable diseases have become leading causes of mortality, the true population prevalence of CKD is unknown and associated risk factors remain understudied. This study aimed to describe the prevalence of kidney dysfunction and associated risk factors in a community from the North West province of South Africa.MethodsThis cross-sectional study included 1999 participants older than 30 years. Kidney dysfunction was defined as (i) estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73m2, or (ii) urine albuminuria-to-creatinine ratio (uACR) ≥ 3.0 mg/mmol, or a combination (i and ii). Risk factors included age, sex, urban/rural locality, body mass index (BMI), blood pressure (BP), lipid profile, haemoglobin A1c (HbA1C), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), tobacco use, and HIV status.ResultsMean age of participants was 48 (42;56) years, and 655/1999 (33%) had eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol. Compared to those with normal kidney function, participants with eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol were older, female, had higher measures of adiposity, systolic, diastolic, and mean arterial blood pressure, serum lipids and C-reactive protein (CRP) (all p ≤ 0.024). In multiple regression analyses eGFR was associated with systolic BP (β = 0.11) and HIV infection (β = -0.09), and albuminuria was associated with elevated CRP (β = 0.12) and HIV infection (β = 0.11) (all p < 0.026). In both groups (individuals with and without kidney dysfunction respectively), eGFR was associated with age (β = -0.29, β = -0.49), male sex (β = 0.35, β = 0.28), BMI (β = -0.12, β = -0.09), low-density/high-density lipoprotein cholesterol ratio (β = -0.17, β = -0.09) and CRP (β = 0.10, β = 0.09) (all p < 0.005); and uACR was associated with female sex (β = 0.10, β = -0.14), urban locality (β = -0.11, β = -0.08), BMI (β = -0.11, β-0.11), and systolic BP (β = 0.27, β = 0.14) (all p < 0.017).ConclusionIn this study from the North West province, South Africa, eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol was prevalent and associated with modifiable risk factors. The findings may inform screening strategies for kidney disease prevention, focusing on women, obesity, blood pressure control, dyslipidaemia, identifying and treating inflammation, and HIV diagnosis and treatment.

‘”A Damnable Blaze”: John Loader Maffey, the North-West Frontier and the Abduction of Mollie Ellis, 1919 – 1923’

ABSTRACT On 14 April 1923, an attack upon the bungalow of Major Ellis in Kohat on India’s North-West Frontier, resulted in the murder of Mrs Ellis and the abduction of their seventeen-year-old daughter, Mollie. Led by Ajab Khan Afridi, the abductors, fled into the independent territory of the Tirah Jowaki. The North-West Frontier represented a contested and strategically sensitive frontier open to both Russian encroachment and the machinations of the Amir of Afghanistan, whilst the Pathan tribal inhabitants were simultaneously characterised as ‘savages’ and independent warriors. Mollie Ellis’s abduction brought into sharp relief the governance and security of the region that pivoted on John Loader Maffey as Chief Commissioner of the North-West Frontier Province. Using the hitherto unpublished collection of papers and letters from Maffey to his wife, Dorothy Gladys Huggins, an assessment of the political, strategic and financial limits of British power through the lens of the man on the ground will be possible. In the final assessment, the abduction of Mollie Ellis demonstrated that Britain’s existence on this strategically sensitive frontier rested upon an uneasy coexistence between the Afghan Amir, the Frontier tribes and the limits of imperial endurance in both Delhi and London.

The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa.

Despite being underreported, orofacial cleft lip/palate (CLP) remains in the top five of South Africa's most common congenital disorders. Maternal air pollution exposure has been associated with CLP in neonates. South Africa has high air pollution levels due to domestic burning practices, coal-fired power plants, mining, industry, and traffic pollution, among other sources. We investigated air pollutant levels in geographic locations of CLP cases. In a retrospective case series study (2006-2020) from a combined dataset by a Gauteng surgeon and South African Operation Smile, the maternal address at pregnancy was obtained for 2,515 CLP cases. Data from the South African Air Quality Information System was used to calculate annual averages of particulate matter (PM) concentrations of particles < 10 µm (PM10) and < 2.5 µm (PM2.5). Correlation analysis determined the relationship between average PM2.5/PM10 concentrations and CLP birth prevalence. Hotspot analysis was done using the Average Nearest Neighbor tool in ArcGIS. Correlation analysis showed an increasing trend of CLP birth prevalence to PM10 (CC = 0.61, 95% CI = 0.38-0.77, p < 0.001) and PM2.5 (CC = 0.63, 95% CI = 0.42-0.77, p < 0.001). Hot spot analysis revealed that areas with higher concentrations of PM10 and PM2.5 had a higher proclivity for maternal residence (z-score = -68.2, p < 0.001). CLP birth prevalence hotspot clusters were identified in district municipalities in the provinces of Gauteng, Limpopo, North-West, Mpumalanga, and Free State. KwaZulu-Natal and Eastern Cape had lower PM10 and PM2.5 concentrations and were cold spot clusters. Maternal exposure to air pollution is known to impact the fetal environment and increase CLP risk. We discovered enough evidence of an effect to warrant further investigation. We advocate for a concerted effort by the government, physicians, researchers, non-government organizations working with CLP patients, and others to collect quality data on all maternal information and pollutant levels in all provinces of South Africa. Collaboration and data sharing for additional research will help us better understand the impact of air pollution on CLP in South Africa.

Filling the gap: Noteworthy herpetological discoveries in North West Province, South Africa

The North West Province, South Africa, is centrally situated in southern Africa and is characterised by savannah with a mesic, temperate climate in the east and a hot, arid climate in the west. While the eastern region is fairly well-documented for herpetofauna, the arid central and western regions are poorly surveyed. Given that the Province has been targeted by the national government for development of infrastructure, the overall deficiency of biodiversity data could result in impact assessments that are not well-informed. We, therefore, carried out herpetofaunal surveys over two years (2019–2020) in the North West Province to improve knowledge on the distributions of reptiles and amphibians. Our surveys added a total of 578 new records to an earlier baseline of 1340 records. In addition, over 300 records were added to a citizen-science platform in connection with our surveys. As compared to the previous 100 years, our surveys increased the herpetofaunal dataset by 68% in just two years, increased geographic coverage by 20% and brought the total number of species with accurate records for the Province to 102 reptiles and 23 amphibians. We also recorded range extensions for five reptile species and confirmed the presence ofDendroaspis polylepis(Black Mamba) in the west where it had been last recorded in 1996. Our surveys resulted in a significant increase in biodiversity data for the Province and provided a better foundation for spatial planning that accounts for biodiversity and the maintenance of ecological function.

Steinernema bakwenae n. sp. (Rhabditida: Steinernematidae), a new entomopathogenic nematode from South Africa

Summary Steinernema bakwenae n. sp. isolate SF857 has been isolated from a soil sample from the North West province of South Africa. The infective juveniles were isolated using Cobb’s decanting and sieving method, hand-picked from the nematode population and inoculated directly onto wax moth larvae. Morphological and molecular characterisation provides evidence for placing the new species in the Khoisanae-clade, adding a fifth member to this all-African clade. The new species is characterised by the following morphological features: third-stage infective juveniles with a body length of 1106 (1013-1233) μm, a distance from the anterior end to the excretory pore of 90 (81-103) μm, and a tail length of 87 (76-103) μm. The first-generation males can be recognised by a spicule length of 80 (66-89) μm and by a gubernaculum length of 51 (44-56) μm. The new species was confirmed by means of crossbreeding and characterised by means of sequences of the internal transcribed spacer (ITS), the partial 28S regions (D2-D3) of the ribosomal DNA and the mitochondrial cytochrome oxidase subunit (COI). Phylogenetic analyses show that S. innovationi and S. tophus are the closest relatives to S. bakwenae n. sp. in the Khoisanae-clade.

Variations in the Functional Diversity of Rhizosphere Microbiome of Healthy and Northern Corn Leaf Blight Infected Maize (Zea mays L.)

Metagenomics is a scientific breakthrough that can reveal the variations in the microbial diversities and functions between the healthy and diseased plants, towards a productive deployment in diverse biotechnological processes and agricultural activities. This study investigated the possible functional diversity in the rhizosphere microbiome of both healthy and Northern Corn Leaf Blight (NCLB) infected maize growing at farms in the Lichtenburg (LI) and Mafikeng (MA) areas of the North West Province, South Africa. We hypothesized variations in the abundance and diversities of microbial functions in the healthy (LI and MA) and diseased (LID and MAD) maize plants. Hence, we extracted DNA from the healthy and diseased maize rhizosphere in the two maize farms and sequenced using a shotgun approach. Using the SEED subsystem, we discovered that the healthy rhizosphere maize plant was dominated by 24 functional categories, while the NCLB infected rhizosphere maize plant was dominated by 4 functional categories. Alpha diversity analysis showed no significant (p &amp;gt; 0.05) difference between the healthy and diseased maize rhizosphere. However, the analysis of beta diversity showed a significant difference. The substantial abundance of functional groups detected especially in LI indicates that presence of plant diseases altered the functions of soil microbiomes. The significant abundance of the unknown role of rhizosphere microbiomes in disease management suggests the presence of some undiscovered functional genes associated with the microbiome of the healthy maize rhizosphere. Hence, further investigation is needed to explore the roles of these functional genes for their agricultural or biotechnological relevance.

Convergence Analysis of Cross-Province Human Well-Being in China: A Spatiotemporal Perspective.

China's economy has been experiencing a new development mode that emphasizes an environmentally friendly green economy and high living standards. The concept of human well-being has become increasingly prominent in recent years to replace GDP per capita as an important indicator for evaluating happiness. In the context of the green economy, it is of great significance to incorporate environmental indicators for evaluating human well-being. To this end, this paper constructs a new human well-being evaluation indicator system including environmental sustainability, and then evaluates the well-being levels of 30 provinces in China from 2011 to 2020 using a comprehensive evaluation method. Then, various statistical methods and visualization methods are used to deeply analyze the spatiotemporal changes in the well-being scores of Chinese provinces during the sample period. Finally, the spatial convergence model was used to verify if cross-province well-being scores would converge to a common steady state. The findings are as follows. (1) The scores of the environmental sustainability subsystem greatly vary from province to province. This is because the local governments have attached great importance to the construction of green ecological civilization in recent years, thus increasing the investment in protecting the ecological environment. (2) From temporal dimensions, overall human well-being scores of 30 provinces slightly increased year after year. In geography, eastern provinces have the highest human well-being scores, followed by northeast, northwest, and southwest provinces. (3) In terms of the scores of the four subsystems, we find that nearly all provinces have their advantages and disadvantages. (4) From the results of the spatial convergence models, both absolute and conditional β convergence have been verified, indicating that the human well-being of all provinces will converge to the common steady state in the future.

Snakebite in South Africa: A retrospective review May 2015–June 2020

Snakebite envenoming in Sub-Saharan Africa present a significant public health problem. An investigation into how often species responsible for envenomation were correctly identified, as well as which venomous species caused the most frequent and problematic envenomation symptomatology were conducted to establish severity of this problem from a South African context. Descriptive statistics were used to quantitatively describe the variables in snakebite related Telelog call records reported to the Poison Information Helpline of the Western Cape (PIHWC) over a five-year period. A total of 1411 snakebite related calls were received. In 44% of all snakebite calls the bite was inflicted by an unidentified snake specie. The most snakebites occurred during the summer months from December–March. The most bites occurred in males (20–39 years). The incidence of snakebite in South Africa was 2.39 per 100 000 population, with the highest incidence of snakebite in North-West province of South Africa. In sub-Saharan Africa there is a major underestimation of the incidence of snakebite due to under reporting and absence of physical attendance to health care facilities. The PIHWC provides an invaluable service in assisting and in-forming medical personnel and the public on the management of snakebites. Data collected by centers provides a source of information on the prevalence of snakebites and medically important species that research should be aimed towards.

Identification of Listeria species and Multilocus Variable-Number Tandem Repeat Analysis (MLVA) Typing of Listeria innocua and Listeria monocytogenes Isolates from Cattle Farms and Beef and Beef-Based Products from Retail Outlets in Mpumalanga and North West Provinces, South Africa.

In this study, Listeria isolates (214) were characterized as follows: L. innocua (77.10%), L. monocytogenes (11.21%), L. welshimeri (5.61%), L. grayi (1.40%), L. seeligeri (0.93%), and L. species (3.73%) that were not identified at the species level, from beef and beef based products from retail and farms in Mpumalanga and North West provinces of South Africa. MLVA was further used to type Listeria innocua isolates (165) and Listeria monocytogenes isolates (24). The L. monocytogenes isolates were also serogrouped using PCR. The MLVA protocol for L. monocytogenes typing included six tandem repeat primer sets, and the MLVA protocol for L. innocua included the use of three tandem repeats primer sets. The L. monocytogenes serogroups were determined as follows: 4b-4d-4e (IVb) (37.50%), 1/2a-3a (IIa) (29.16%), 1/2b-3b (IIb) (12.50%), 1/2c-3c (IIc) (8.33%), and IVb-1 (4.16%). MLVA could cluster isolates belonging to each specie, L. monocytogenes, and L. innocua isolates, into MLVA-related strains. There were 34 and 10 MLVA types obtained from the MLVA typing of L. innocua and L. monocytogenes, respectively. MLVA clustered the L. monocytogenes isolates irrespective of sample category, serogroups, and geographical origin. Similarly, the L. innocua isolates clustered irrespective of meat category and geographical origin. MLVA was able to cluster isolates based on MLVA relatedness. The clustering of isolates from farms and retailers indicates transmission of Listeria spp. MLVA is an affordable, simple, and discriminatory method that can be used routinely to type L. monocytogenes and L. innocua isolates.

The investigation of Culicoides (Diptera: Ceratopogonidae) species and Bluetongue virus and Schmallenberg virus in Northwest Türkiye.

Culicoides biting midges (Diptera: Ceratopogonidae) act as mechanical and biological vectors of arboviruses and are crucial in the global spread of these viruses. This study investigated the diversity of distribution of Culicoides species and the presence of Bluetongue virus (BTV) and Schmallenberg virus (SBV) in Tekirdağ province in Northwest Türkiye. The fourteen Culicoides species, such as Culicoides newsteadi, Culicoides schultzei,Culicoides nubeculosus comp., Culicoides punctatus, Culicoides circumscriptus, Culicoides obsoletus comp., Culicoides gejgelensis, Culicoides festivipennis, Culicoides longipennis, Culicoides spp., Culicoides pulicaris, Culicoides picturatus, Culicoides odiatus, Culicoides kurensis, and Culicoides flavipulicaris, were detected. Culicoides newsteadi, C. odiatus, and C. pulicaris were the most abundant species. Phylogenetic analyses of Culicoides species' ITS-1 gene region were performed. A pool of C. festivipennis was positive for SBV RNA, while the BTV genomic materials was not found in the qPCR analysis. This is the first report of the presence/detection of SBV in Culicoides species in Türkiye. The survey of bioecological and epizootiological aspects of vector species is essential in implementing effective control measures for arboviral infections.

“They are gaining experience; we are gaining extra hands”: a mixed methods study to assess healthcare worker perceptions of a novel strategy to strengthen human resources for HIV in South Africa

BackgroundLay health workers (LHWs) can support the HIV response by bridging gaps in human resources for health. Innovative strategies are needed to expand LHW programs in many low- and middle-income countries. Youth Health Africa (YHA) is a novel LHW approach implemented in South Africa that places young adults needing work experience in one-year non-clinical internships at health facilities to support HIV programs (e.g., as HIV testers, data clerks). While research suggests YHA can increase HIV service delivery, we need to understand healthcare worker perceptions to know if this is an acceptable and appropriate approach to strengthen human resources for health and healthcare delivery.MethodsWe conducted a convergent mixed methods study to assess healthcare worker acceptance and perceived appropriateness of YHA as implemented in Gauteng and North West provinces, South Africa and identify issues promoting or hindering high acceptability and perceived appropriateness. To do this, we adapted the Johns Hopkins Measure of Acceptability and Appropriateness to survey healthcare workers who supervised interns, which we analyzed descriptively. In parallel, we interviewed frontline healthcare workers who worked alongside YHA interns and conducted an inductive, thematic analysis. We merged quantitative and qualitative results using the Theoretical Framework of Acceptability to understand what promotes or hinders high acceptance and appropriateness of YHA.ResultsSixty intern supervisors responded to the survey (91% response rate), reporting an average score of 3.5 for acceptability and 3.6 for appropriateness, on a four-point scale. Almost all 33 frontline healthcare workers interviewed reported the program to be highly acceptable and appropriate. Perceptions that YHA was mutually beneficial, easy to integrate into facilities, and helped facilities be more successful promoted a strong sense of acceptability/appropriateness amongst healthcare workers, but this was tempered by the burden of training interns and limited program communication. Overall, healthcare workers were drawn to the altruistic nature of YHA.ConclusionHealthcare workers in South Africa believed YHA was an acceptable and appropriate LHW program to support HIV service delivery because its benefits outweighed its costs. This may be an effective, innovative approach to strengthen human resources for HIV services and the broader health sector.

Worsening Carbon Inequality Embodied in Trade within China.

The mismatch between trade-embodied economic benefits and CO2 emissions causes carbon inequality, which is seldom analyzed from the intracountry level, especially across a long-term period. This study applied an environmentally extended multiregional input-output model to trace this mismatch and measure the carbon inequality quantitatively within China during 2007-2017. The results show that during the past decade, China's national carbon inequality was continuously worsening with carbon Gini coefficients rising regardless of production- (0.21-0.30) or consumption-based (0.12-0.18) accounting. The regional carbon inequality was deteriorating, where less developed provinces with 20% of total value-added emitted 32.9% of total CO2 emissions in 2007, while this figure rose to 42.6% in 2017. The eastern provinces (Jiangsu and Shanghai) had entered into net economic and carbon beneficiaries keeping high trade advantages, by contrast the northwest provinces (Ningxia and Xinjiang) were trapped in a lose-lose situation with trade benefits declining by 68%. The southwest provinces (Yunnan and Guangxi) shifted from being net carbon and value-added exporters to net importers, stepping into the earlier development mode of eastern provinces. This hidden and exacerbated carbon inequality calls for regional-specific measures to avoid the dilemma of economic development and CO2 mitigation, which also gives a good reminder for the rising economies, like India.

Indigenous Foods in Decline? A Study on Changing Consumption Patterns Within the Barolong Boo Ratshidi Community, Northwest Province of South Africa

ABSTRACT This study examines changes in food consumption patterns within African communities, with specific reference to the Barolong Boo Ratshidi community in the Northwest Province of South Africa. The study uses a qualitative approach through in-depth interviews conducted with members of this community (or participants) to understand their views of food and consumption patterns. It also sought to understand the participants’ understanding of the factors behind these changes and their effects as well as their understanding of the meanings underlying indigenous African foods. It was found that contrary to the widely held view that only the elderly members of communities are endeared to indigenous foods, this is not so because the youth also express preference for these foods while embracing changes that have effect on their consumption. This is so even though many of the youth are ignorant of the cultural meanings of indigenous African foods served on different occasions. Their enthusiasm for these foods is seen as an optimistic basis for future efforts meant to revitalize them.

Factors influencing the clinical mentoring of nursing students at a hospital in the North West Province

IntroductionClinical mentoring is a strategy designed to improve the clinical competencies of nursing students after completion of their training. Effective clinical mentoring of nursing students during training leads to highly competent and skilled professional nurses which ultimately leads to quality nursing care of patients. However, clinical mentoring has been confronted with challenges globally which could have severe implications on the competency of nursing students as future professionals and consequently affects the nursing profession. PurposeThe purpose of the study was to explore and describe the factors influencing the clinical mentoring of nursing students at a hospital in the North West Province. MethodsThe research employed a qualitative, exploratory and descriptive research design. The population of the study were all professional nurses working at a hospital in the North West Province. A non-probability purposive sampling technique was used to select participants. Data were collected through individual semi-structured interviews. The research sample was determined by data saturation which was reached after interviewing fourteen participants. The researchers, supervisor and co-coder separately analysed data using Tesch's eight steps in the Coding Process. ResultsTwo main themes were extracted from the data: student and mentors related factors. Both themes emerged as the promoters and hindrances of clinical mentoring. ConclusionsGrounded in the findings of this research it can be concluded that there are factors promoting and hindering clinical mentoring of nursing students. However, the findings suggest that there is a need for in-service training for professional nurses on the concept clinical mentoring, as it is not clearly understood.

Facilitators and barriers to implementing antimicrobial stewardship programs in public South African hospitals.

The South African National Department of Health released guidelines and recommendations for antimicrobial stewardship (AMS) programs to be established in public healthcare facilities. Their implementation remains challenged, especially in North West Province, where the public health system functions under severe strain. This research explored and interpreted the facilitators that strengthen and barriers that hinder the implementation of the national AMS program in public hospitals in North West Province. A qualitative design and interpretive descriptive approach enabled insight into the realities of AMS program implementation. Public hospitals in North West Province, sampled through criterion sampling (n = 5). Purposive criterion sampling of healthcare practitioners (n = 30) actively participating in AMS programs in the 5 sampled public hospitals. Qualitative, interpretive description with semi-structured individual interviews that were digitally recorded and transcribed. The ATLAS.ti version 8 software facilitated content analysis, followed by second-level analysis. In total, 4 themes, 13 categories, and 25 subcategories emerged. We detected dissonance between government AMS ideals and the realities of AMS program implementation in public hospitals. A multilevel AMS leadership and governance vacuum exists in a dysfunctional health ecosystem in which AMS must operate. Healthcare practitioners agreed on the importance of AMS despite different understandings of AMS and ineffective multidisciplinary teams. Discipline-specific education and training are essential for all AMS participants. AMS is essential yet complex, and its contextualization and implementation are underestimated in public hospitals. Recommendations are focused on a supportive organizational culture, contextualized AMS program implementation plans, and changes in management.

Orthopaedic surgical antibiotic prophylaxis administration compliance with prescribing guidelines in a private hospital in North West province, South Africa

BACKGROUND: The correct use of surgical antibiotic prophylaxis (SAP), as stipulated in evidence-based guidelines, is essential to prevent surgical site infections (SSIs) following orthopaedic procedures and consequently the impact thereof on the patient and healthcare system. Orthopaedic SSIs are associated with devastating complications with a great burden of disease on patients. METHODS: A cross-sectional study was performed in a 186-bed private hospital, located in North West province, South Africa. Retrospective data of adult patients who underwent orthopaedic surgery from 1 January 2020 to 31 December 2020 were included. Data were obtained from the study hospital's theatre registers, anaesthetic notes, patient medical records and patient antimicrobial prescription charts. Descriptive statistical analysis was used to determine the compliance (indication, choice, route of administration, dose, administration time, re-dosing and duration) of orthopaedic SAP administration with prescribing guidelines. RESULTS: Of the 942 orthopaedic procedures, SAP was correctly administered or omitted in 742 cases (78.8%). The total choice of SAP was correct in 738 cases (78.3%). SAP was administered intravenously 100% of the time and was prescribed at the correct dose in 632 cases (77.5%). However, SAP re-dosing occurred only in one of the three prolonged procedures, and the preoperative SAP administration time was only indicated in 34.4% of the cases. The correct duration of SAP was 75.9%. The overall compliance rate to SAP guidelines regarding indication, choice, dose and duration was 57.5%. SSIs developed in 0.9% of the patients, resulting in the death of one. CONCLUSION: Orthopaedic SAP practices moderately deviated from current SAP guidelines. Apparent overuse, incorrect dosing and prolonged duration were identified as burdens to overcome. Special attention should be paid to dosing adjustments for patients weighing more than 120 kg. However, certain components such as route of administration, administration time, SAP indication and SAP correct choice showed greater compliance percentages. The low prevalence of SSIs supports a positive reporting of the findings Level of evidence: Level 4.

Patients’ experiences of treatment migration from ART triple pill to fixed-dose combination therapy in Ngaka Modiri Molema District, North West Province, South Africa

Patients’ experiences of treatment migration from ART triple pill to fixed-dose combination therapy in Ngaka Modiri Molema District, North West Province, South Africa

Knowledge, attitudes, practices and intention to get vaccinated against COVID-19: results from a cross-sectional survey in three peri-urban communities in South Africa.

South Africa has the largest number of confirmed cases of COVID-19 in Africa. Data to inform public health strategies to mitigate the spread of new variants and severity of disease is needed, including information on knowledge, attitudes and practices (KAP) regarding COVID-19, factors associated with intention to get vaccinated, and viewpoints on reliable sources of data. we investigated these topics as part of the COVID-19 healthcare utilization and seroprevalence (HUTS) cross-sectional survey in three communities in South Africa: Mitchell´s Plain (Western Cape Province), Pietermaritzburg (KwaZulu-Natal Province) and Klerksdorp (North West Province) during and after the second wave of COVID-19 prior to vaccine availability. primary caregivers from 5799 households participated in the study, 41.1% from Pietermaritzburg, 34.2% from Klerksdorp and 24.7% from Mitchells Plain. Two-thirds and 94.7% of respondents had correct knowledge on the cause and spread of COVID-19, respectively. Knowledge measures were significantly associated with age less than 65 years, the highest level of education and site (Mitchells Plain). Desired preventive behaviors were associated with higher socio-economic status. While 64.7% of people intended to get vaccinated, those over 64 years of age were more likely to intend to vaccinate (aOR: 1.25, 95% CI: 1.06-1.47). Vaccine intention related to protection of self (58.4%) and family (40.0%). The most trusted source of COVID-19 information was television (59.3%) followed by radio (20.0%). these data can be used to design targeted public health campaigns for the current COVID-19 and future epidemics, ensuring that socio-economic constraints and preference for trusted information are considered.

Features of the Activities of Political Agents in the Tribal Area of the North-West Frontier Province of British India (1919–1939)

The special form of government of the North-West Frontier Province, analyzed in the article, was established through the interaction of British political agents with local tribes. The territory under consideration was characterized by a high level of instability, which they tried to neutralize by creating a multi-level management system, as well as establishing parity among local elites with British mediation as an arbiter. The administrative system formed by agents has survived, territorially related to modern Pakistan, with its characteristic problems, which is presented as the historical experience of British India in controlling its northwestern border. The main task of the British officers was to establish a controlled system of checks and balances in the border zone, aimed at resolving issues of ensuring the reliable protection of British India from external threats. At the same time, the possibility of a foothold for the territory under consideration was created for further geopolitical competition in Asia. The presented hierarchy of subordination removed this region from the general system of colony management and prevented reforms. The tribal area was under the territorial jurisdiction of British India, had full autonomy with limited agents who had representation in local jirgas and coordinated the actions of the militias, self-defense units, scouts. The implementation of the set installations was carried out using a number of mechanisms for the management of the province, concluded in diplomatic agreements, supported by financial payments in favor of the local elite, as well as by engaging the Indian army in particularly unstable areas.

Validation and Improvement of a Machine Learning Model to Predict Interruptions in Antiretroviral Treatment in South Africa.

Machine learning algorithms are increasingly being used to inform HIV prevention and detection strategies. We validated and extended a previously developed machine learning model for patient retention on antiretroviral therapy in a new geographic catchment area in South Africa. We compared the ability of an adaptive boosting algorithm to predict interruption in treatment (IIT) in 2 South African cohorts from the Free State and Mpumalanga and Gauteng and North West (GA/NW) provinces. We developed a novel set of predictive features for the GA/NW cohort using a categorical boosting model. We evaluated the ability of the model to predict IIT over all visits and across different periods within a patient's treatment trajectory. When predicting IIT, the GA/NW and Free State and Mpumalanga models demonstrated a sensitivity of 60% and 61%, respectively, able to correctly predict nearly two-thirds of all missed visits with a positive predictive value of 18% and 19%. Using predictive features generated from the GA/NW cohort, the categorical boosting model correctly predicted 22,119 of a total of 35,985 missed next visits, yielding a sensitivity of 62%, specificity of 67%, and positive predictive value of 20%. Model performance was highest when tested on visits within the first 6 months. Machine learning algorithms may be useful in informing tools to increase antiretroviral therapy patient retention and efficiency of HIV care interventions. This is particularly relevant in developing countries where health data systems are being strengthened to collect data on a scale that is large enough to apply novel analytical methods.