Resource-poor Communities Research Articles

Leveraging the South African Diabetes Prevention Programme to screen for chronic kidney disease: an observational study

ObjectiveTo evaluate the viability of leveraging an existing screening programme (the South African Diabetes Prevention Programme (SA-DPP)) to screen for chronic kidney disease (CKD), by assessing the yield of CKD...

The accuracy of nucleic acid amplification tests (NAATs) in detecting human intestinal nematode infections: A protocol for a systematic review and meta-analysis.

Human intestinal nematode infections are a global public health issue as they can result in considerable morbidity in infected individuals, mainly in developing countries. These infections continue to go undiagnosed, as they tend to be mainly endemic in resource-poor communities where there is a shortage of experienced laboratory staff and relevant diagnostic technologies. This is further exacerbated by the nature of intermittent shedding of eggs and larvae by these parasites. Diagnostic methods range from simple morphological identification to more specialised high-throughput sequencing technologies. Microscopy-based methods, although simple, are labour-intensive and considerably less sensitive than molecular methods which are rapid and have high levels of accuracy. Molecular methods use nucleic acid amplification (NAA) to amplify the deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) fragments of the parasite to detect and determine its presence using different technologies (NAAT). They have increased the sensitivity of detection and quantitation of intestinal nematode infections, especially in low infection intensity settings. The absence of a gold standard test limits current diagnosis and, in turn, restricts intervention measures and effective control efforts. The objective of this review is to determine the accuracy of NAATs in detecting human intestinal nematode infections using Kato-Katz as the reference test for the most common soil-transmitted helminth (STH) infections and the scotch tape test for enterobiasis and Baermann method for strongyloidiasis. Relevant studies will be identified by searches in electronic databases. Two reviewers will independently screen the literature against eligibility criteria. The methodological quality of studies will then be appraised by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Discrepancies will be addressed by a third reviewer. The true positives, false positives, true negatives and false negatives of all the studies will be extracted into contingency tables. In paired forest plots, study-specific sensitivity and specificity with a 95 per cent confidence interval will be displayed. The systematic review of this protocol will report the diagnostic accuracy of currently available NAATs for the detection of human intestinal nematode infections. This will help healthcare providers and administrators determine the diagnostic method to be used in different clinical and preventive settings. Trial registration: PROSPERO registration number for this protocol is CRD42022315730.

Effect of artificial insemination in comparison to natural mating on the reproductive performance and profitability of smallholder pig production system in Indian Himalaya

In fragile ecosystems, smallholder pig production systems provide food and nutritional security to resource-poor communities. Pigs are the main livestock raised by indigenous communities in the Himalayan region of India, but their productivity is low for several reasons. The present study aimed to study the pig herd size and to evaluate the impact of artificial insemination (AI) on profitability and sustainability in the small-holder pig production system. A total of 612 AIs were carried out in 483 sows in the farmer's field along with 114 sows that underwent natural breeding. A comparison was made between the reproductive performance of sows following AI and natural breeding. The profitability and economics of AI and natural breeding were also compared. The mean pig population varied from 4.75 to 6.42 in the study region. The farrowing rate, total born piglets (TBPs), and live born piglets (LBPs) were significantly higher (P< 0.001) in artificially inseminated sows compared to naturally bred sows (9.37 vs. 6.28; 8.93 vs. 5.45). Farrowing rate (P= 0.005), TBP, and LBP were significantly (P< 0.001) higher in sows inseminated by female inseminator as compared to male inseminator (81.26 vs. 71.42%; 9.65 vs. 8.80; 9.21 vs. 8.38). The insemination by uneducated farmers resulted in significantly (P= 0.002) lower farrowing rate, TBP (P< 0.001), LBP (P< 0.001), and AI per farrowing (P= 0.042). The farmers who did AI for the third time and more than three times recorded significantly (P< 0.001) higher farrowing rates, TBP, and LBP. The farrowing rate was significantly (P< 0.001) less in sows that were located more than 30 km away from the semen center (66.66 vs. 82.90%). The net return per sow was significantly higher (P< 0.001) in artificially inseminated sows (US$464.8 vs. US$248.11). AI resulted in an 87.33% increase in net returns per farrowing as compared to natural breeding. In conclusion, AI in smallholder pig production systems has the potential to sustainably improve the profitability as well as the food and nutritional security of resource-poor farmers.

Arbovirus and its potential to lead the next global pandemic from sub-Saharan Africa: What lessons have we learned from COVID-19?

Risk and predisposing factors for viral zoonoses abound in the sub-Saharan Africa (SSA) region with significant public health implications. For several decades, there have been several reports on the emergence and re-emergence of arbovirus infections. The lifetime burden of arboviral diseases in developing countries is still poorly understood. Studies indicate significant healthcare disruptions and economic losses attributed to the viruses in resource-poor communities marked by impairment in the performance of daily activities. Arboviruses have reportedly evolved survival strategies to aid their proliferation in favorable niches, further magnifying their public health relevance. However, there is poor knowledge about the viruses in the region. Thus, this review presents a survey of zoonotic arboviruses in SSA, the burden associated with their diseases, management of diseases as well as their prevention and control, mobility and determinants of infections, their vectors, and co-infection with various microorganisms. Lessons learned from the ongoing coronavirus disease 2019 (COVID-19) pandemic coupled with routine surveillance of zoonotic hosts for these viruses will improve our understanding of their evolution, their potential to cause a pandemic, control and prevention measures, and vaccine development.

Contextual Pathways Linking Cumulative Experiences of Racial Discrimination to Black American Men's COVID Vaccine Hesitancy.

The COVID-19 pandemic has revealed and widened racialized health disparities, underscoring the impact of structural inequities and racial discrimination on COVID-19 vaccination uptake. A sizable proportion of Black American men report that they either do not plan to or are unsure about becoming vaccinated against COVID-19. The present study investigated hypotheses regarding the mechanisms by which experiences of racial discrimination are associated with Black American men's COVID-19 vaccine hesitancy. Hypotheses were tested using structural equation modeling with 4 waves of data from 242 Black American men (aged ~ 27) living in resource-poor communities in the rural South. Study findings revealed that racial discrimination was indirectly associated with COVID-19 vaccine hesitancy via increased endorsement of COVID-19 conspiratorial beliefs. Findings also demonstrated that increased levels of ethnic identity strengthen the association between experiences of racial discrimination and COVID-19 conspiratorial beliefs. In contrast, increased levels of social support weakened the association between cumulative experiences of racial discrimination and COVID conspiratorial beliefs. Taken together, these results suggest that racial discrimination may promote conspiratorial beliefs which undermine Black American men's willingness to be vaccinated. Future interventions aimed towards promoting vaccine uptake among Black American men may benefit from the inclusion of targeted efforts to rebuild cultural trust and increase social support.

Community Characteristics and Niche Analysis of Soil Animals in Returning Farmland to Forest Areas on the Loess Plateau

Niche theory is significant for understanding the function of community structure, interspecific relationships, and community dynamic succession. However, there are few studies on the soil animal niche in returning farmland to forest areas on the Loess Plateau, making it challenging to comprehend the utilization of soil animal resources, the stability of the local community, and the succession process in the areas. Therefore, this study collected soil animals in five typical vegetation types: Robinia pseudoacacia (R), Hippophae rhamnoides (H), Populus simonii (P), Pinus tabulaeformis (T), and Armeniaca sibirica x Hippophae rhamnoides (M), with abandoned grassland (G) used as a control group. Then, the number of soil animal taxa, individuals, diversity, and niche were sampled and examined in the study areas during the four seasons of spring, summer, autumn, and winter using the manual sorting method and the Tullgren method. The results revealed that 3872 soil animals from 3 Phyla, 8 Classes, 22 Orders, and 49 Families were captured in the study areas. The dominant groups of soil macrofauna were Diptera larvae, Julidae, and Formicidae, and the dominant groups of meso–micro soil fauna were Oribatida, Protospira, and Collembola juveniles. Soil animals have rich nutritional function groups, with the most saprophytic soil animal groups. The individual density and taxa number of soil animals in G were lower than other vegetation on the whole. H, M, and P had a higher Shannon–Winner index than the other vegetation. Seasonal changes had different effects on macro and meso–micro soil fauna. The diversity of soil macrofauna is higher in spring and summer, and that of meso–micro soil fauna is higher in autumn and winter. Oribatida, Diptera Larvae, and Formicidae had a large niche width in the main taxa of soil animals, with universal adaptability to the environment. Cicadellidae and Culicidae had narrow niche widths and were highly dependent on resources and the environment. There were 67 pairs of highly overlapped (Oik > 0.8) taxa of soil animals and 56 pairs of moderately overlapped (0.6 < Oik ≤ 0.8) taxa, accounting for 80.39% of the total number of taxa. Soil animals had high commonality in resource utilization, intense competition, and poor community stability. As a result, we can conclude that the soil animal community in the study areas was in the stage of succession.

Cleome gynandra: A wonder climate-smart plant for nutritional security for millions in semi-arid areas.

Spider plant (Cleome gynandra) is predominantly used as a traditional leafy vegetable throughout Africa and is considered a rich natural source of essential nutrients such as vitamins, minerals and proteins. With the increase in malnutrition, diet related non-communicable diseases and poverty across the continent of Africa, the spider plant is a bona fide alternative healthy food crop to alleviate these challenges. Spider plant is an erect annual herb that could grow up to 150 cm tall, strongly branched, with a long taproot and few secondary roots. It is commonly consumed in resource-poor communities especially during times of major food scarcity. It is a drought-tolerant and resilient annual vegetable crop capable of growing well in a wide range of climatic and edaphic conditions. Despite the potential benefits and wide adaptability, progressive attempts towards the development of C. gynandra as a crop have been impeded by issues like low investment in research and development resulting in poor seed quality, relatively low yields and susceptibility to pests and diseases. In this paper, we reviewed the research that has been done regarding its morphology, growing conditions, production and utilisation (i.e., nutrition). The current review highlighted the status of the science in advancing the domestication of C. gynandra as a potential power crop for several African countries. The review concluded that with the advancement of modern biotechnology techniques and genome sequencing, there is a compelling case for investment and development in C. gynandra as a candidate for managing micronutrient deficiencies during the post-pandemic era. Finally, the existing knowledge gaps (e.g., breeding) that necessitate explorations were identified and recommendations that could enhance its development and potential commercialisation were made.

Prevalence and Distribution of Hard Ticks and Their Associated Risk Factors in Sheep and Goats from Four Agro-Climatic Zones of Khyber Pakhtunkhwa (KPK), Pakistan.

: BackgroundHard ticks are blood-sucking ectoparasites infesting all types of domestic ruminants throughout the world and serve as vectors in the dissemination of a wide variety of pathogens. Sheep and goat farming is a vital economic source for resource-poor farming communities in the Khyber Pakhtunkhwa (KPK) province of Pakistan. Aim: The aim of present study is to study the epidemiological profile of ticks in various agro-climatic zones of KPK. Materials and Methods: A total of 1500 (882 sheep and 618 goats) of all age groups and sexes were examined for the presence of ticks belonging to six districts in four agro-climatic zones of KPK province, Pakistan. Non-probability sampling was undertaken based on animal hosts’ selection, collection of hard ticks, and epidemiological parameters. Ticks collected from sheep and goats were identified phenotypically using standard keys. Results: The results revealed that Rhipicephalus microplus (36.2%) was the predominant tick species followed by Hyalomma anatolicum (25.2%), Hyalomma trancatum (18.1%), Hyalomma aegyptium (11.3%), Hyalomma asiaticum (6.9%), and Haemephysalis bispinosa (2.4%). Different epidemiological parameters showed that weather, humidity, and host age negatively affect (p < 0.05) tick load while temperatures (Minimum and Maximum), sunshine (hrs), and precipitation positively affected (p < 0.05) tick load. Host sex only showed a positive association with tick load (p > 0.05). The highest value of tick diversity index (H) 0.36748 was noted for Hyalomma anatolicum as this tick species was commonly distributed in three agro-climatic zones except in the Suleiman Piedmont zone, while Haemaphysalis bispinosa has the lowest diversity index (0.0334) as it was only found in the Central Valley Plains zone of KPK. The Shannon diversity index of tick diversity was highest at Barikot while the lowest index value was at Kabal (2.407). Similarly, a higher Simpson’s diversity index was at Barikot (0.9554) and the lowest hard index was noted at Takht bai (2.874). The dominance index showed that the tick species were more dominant at Takht bai (0.1251), while the lowest dominance was at Barikot (0.04465). Conclusions: It has been concluded that tick diversity and distribution, abundance, reproduction, development, and survival depend on prevailing climatic conditions. The present study would not only help to identify the tick species but also facilitate in devising effective control measures to minimize the transmission pathogens in sheep and goats being reared in the various agro-climatic zones of KPK province, Pakistan.

VIRAL DETECTION IN TICKS AND THE LEVEL OF TICKS’ INFESTATIONS AMONGST SMALL RUMINANTS IN MAIDUGURI, BORNO STATE

Ticks were the first arthropods to be established as vectors of pathogens and are currently recognized, along with mosquitoes, as the main arthropod vectors of disease agents to humans and domestic animals globally due to increased incidences of tick-borne diseases (TBDs) the world over. They are responsible for the transmission of many viral diseases to humans and domestic animals. Therefore, ticks infection and infestation results in great economic losses to resource-poor farming communities, especially in tropical and subtropical regions, including Nigeria, where approximately 80% of the world’s cattle population is raised. The current study is aimed to study the distribution, composition and abundance of ticks in Maiduguri, Borno State. Adult ticks were collected from 350 freshly butchered small ruminants (sheep and goats) from three locations within Maiduguri metropolis namely:Kasuwa shanu, Bulumkutu, and Maiduguri Central Abattoir. These were identified using taxonomy identification keys in to three species, Rhipicephalus, Amblyomma and Hyalomma, using stereomicroscope for each of the locations. They were crushed using bullet blender after the addition of glass beads and centrifuged. The supernatant from the crushed samples was used for viral detection by inoculating it on to two cell lines, Baby Hamster Kidney (BHK) and African Monkey Kidney (Vero E6), and were observed for cytopathic effects daily for a period of ten (10) days. The results showed a high level of ticks’ infestation amongst small ruminants in the study locations. Kasuwan Shanu has the highest distribution of ticks amongst sheep, followed by Maiduguri Central Abattoir while Bulumkutu has the least. More also, Kasuwan Shanu has the highest distribution of ticks amongst goats, followed by Bulumkutu while Maiduguri Central Abbatoir has the least. The three species of ticks investigated were found to comprise of either male or female or both in the different locations, and either of the two sexes is involved in the infestation. The results also showed the presence of virus in some of the tick samples isolated from the small ruminants andinoculated on to the cell lines due to the observed cytopathic effects. It is concluded that there is high level of ticks’ infestation among small ruminants in Maiduguri metropolis and a threat of viral disease transmission to humans and other animals.

Cross-sectional analysis of the association between personal exposure to household air pollution and blood pressure in adult women: Evidence from the multi-country Household Air Pollution Intervention Network (HAPIN) trial

Elevated blood pressure (BP) is a leading risk factor for the global burden of disease. Household air pollution (HAP), resulting from the burning of biomass fuels, may be an important cause of elevated BP in resource-poor communities. We examined the exposure-response relationship of personal exposures to HAP —fine particulate matter (PM2.5), carbon monoxide (CO), and black carbon (BC) — with BP measures in women aged 40–79 years across four resource-poor settings in Guatemala, Peru, India and Rwanda. BP was obtained within a day of 24-h personal exposure measurements at baseline, when participants were using biomass for cooking. We used generalized additive models to characterize the shape of the association between BP and HAP, accounting for the interaction of personal exposures and age and adjusting for a priori identified confounders. A total of 418 women (mean age 52.2 ± 7.9 years) were included in this analysis. The interquartile range of exposures to PM2.5 was 42.9–139.5 μg/m3, BC was 6.4–16.1 μg/m3, and CO was 0.5–2.9 ppm. Both SBP and PP were positively associated with PM2.5 exposure in older aged women, achieving statistical significance around 60 years of age. The exact threshold varied by BP measure and PM2.5 exposures being compared. For example, SBP of women aged 65 years was on average 10.8 mm Hg (95% CI 1.0–20.6) higher at 232 μg/m3 of PM2.5 exposure (90th percentile) when compared to that of women of the same age with personal exposures of 10 μg/m3. PP in women aged 65 years was higher for exposures ≥90 μg/m3, with mean differences of 6.1 mm Hg (95% CI 1.8–10.5) and 9.2 mm Hg (95% CI 3.3–15.1) at 139 (75th percentile) and 232 μg/m3 (90th percentile) respectively, when compared to that of women of the same age with PM2.5 exposures of 10 μg/m3. Our findings suggest that reducing HAP exposures may help to reduce BP, particularly among older women.

The Transition to Fatherhood, Contextual Stress, and Substance Abuse: A Prospective Analysis of Rural, Emerging Adult Black American Men

Background: Among Black American emerging adult men (∼aged 18–25), the early transition to fatherhood is often marred by numerous contextual stressors related to racial discrimination and socioeconomic instability. The strain of transitioning to fatherhood while experiencing high levels of contextual stress may evidence escalations in substance misuse over time as men may turn to substances to cope with the stress of complex life transitions. However, research examining these associations are scarce. Objective: This study aimed to investigate the influence of contextual stress on the association between fatherhood and substance misuse. Hypotheses were tested using multiple linear regression with 3 waves of data from 476 Black American men aged 19 to 22 at baseline living in resource-poor communities in the rural South. Results: Results demonstrated that fatherhood status was associated, prospectively, with Black American fathers’ substance misuse when exposure to contextual stress was high but not low. Conclusions: Findings underscore the need for substance misuse prevention programs to (a) support Black American fathers in coping with race-related stress and (b) integrate robust socioeconomic stability services in order in disrupt patterns of future substance misuse by improving Black American men’s experience of the transition to fatherhood.

Mapping the unsafe school journey: Rural primary school children’s perspectives on dangerous social geographies in South Africa

This paper describes a study conducted with 20 primary school children from a resource-poor rural community in South Africa. Using participatory mapping, the school children were asked to draw the paths they walked to school (referred to as child maps), and identify unsafe areas on this journey. The data were analyzed using participatory visual analysis techniques by focusing on the children’s representations of their school journeys and their perspectives on their vulnerability on these paths. The analysis revealed a plethora of areas that posed a threat to children as they walked to school. Moreover, the findings suggest that children experienced heteropatriarchal violence on their school journeys, which evoked fear and anxiety since they associated this walk with risk. Using participatory mapping offered a unique opportunity to see how school children constructed and navigated the routes they walked to school, and how on these paths, different forms of violence occurred. The children’s maps offered an important tool for understanding the significance of space and place on routes to school in rural communities.

Transmission of gram-negative antibiotic-resistant bacteria following differing exposure to antibiotic-resistance reservoirs in a rural community: a modelling study for bloodstream infections

Exposure to community reservoirs of gram-negative antibiotic-resistant bacteria (GN-ARB) genes poses substantial health risks to individuals, complicating potential infections. Transmission networks and population dynamics remain unclear, particularly in resource-poor communities. We use a dynamic compartment model to assess GN-ARB transmission quantitatively, including the susceptible, colonised, infected, and removed populations at the community-hospital interface. We used two side streams to distinguish between individuals at high- and low-risk exposure to community ARB reservoirs. The model was calibrated using data from a cross-sectional cohort study (N = 357) in Chile and supplemented by existing literature. Most individuals acquired ARB from the community reservoirs (98%) rather than the hospital. High exposure to GN-ARB reservoirs was associated with 17% and 16% greater prevalence for GN-ARB carriage in the hospital and community settings, respectively. The higher exposure has led to 16% more infections and attributed mortality. Our results highlight the need for early-stage identification and testing capability of bloodstream infections caused by GN-ARB through a faster response at the community level, where most GN-ARB are likely to be acquired. Increasing treatment rates for individuals colonised or infected by GN-ARB and controlling the exposure to antibiotic consumption and GN-ARB reservoirs, is crucial to curve GN-ABR transmission.

Risk and Resilience Pathways, Community Adversity, Decision-making, and Alcohol Use Among Appalachian Adolescents: Protocol for the Longitudinal Young Mountaineer Health Study Cohort.

BackgroundAlcohol use impairs psychosocial and neurocognitive development and increases the vulnerability of youth to academic failure, substance use disorders, and other mental health problems. The early onset of alcohol use in adolescents is of particular concern, forecasting substance abuse in later adolescence and adulthood. To date, evidence suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to the early onset of alcohol use.ObjectiveThe objective of the Young Mountaineer Health Study is to investigate the influence of contextual and health behavior variables on the early onset of alcohol use among middle school–aged youth in resource-poor Appalachian rural communities.MethodsThis is a program of prospective cohort studies of approximately 2200 middle school youth from a range of 20 rural, small town, and small city (population <30,000) public schools in West Virginia. Students are participating in 6 waves of data collection (2 per year) over the course of middle school (sixth to eighth grades; fall and spring) from 2020 to 2023. On the basis of an organizational arrangement, which includes a team of local data collection leaders, supervising contact agents in schools, and an honest broker system to deidentify data linked via school IDs, we are able to collect novel forms of data (self-reported data, teacher-reported data, census-linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school.ResultsIn the spring of 2021, 3 waves of student survey data, 2 waves of data from teachers, and a selection of archival school records were collected. Student survey wave 1 comprised 1349 (response rate 80.7%) participants, wave 2 comprised 1649 (response rate 87%) participants, and wave 3 comprised 1909 (response rate 83.1%) participants. The COVID-19 pandemic has had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system have proven vitally important in mitigating the potentially far greater negative impact of the pandemic on our data collection processes.ConclusionsThe Young Mountaineer Health Study will use a large data set to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Furthermore, the program will test hypotheses regarding contextual factors (eg, parenting practices and neighborhood collective efficacy) that protect youth from community disadvantage and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. Data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic in 2020 and 2021.International Registered Report Identifier (IRRID)DERR1-10.2196/40451

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.

Ureterovaginal Fistula: An Audit of Treatment Options in an Underdeveloped Area of Pakistan

Throughout 2021, we were requested to assess and treat 10 women who had suffered ureterovaginal fistulas after caesarean sections at separate remote hospitals. We describe our experiences diagnosing and treating uninsured patients at a hospital with minimal resources. A three-swab test was conducted on each of the 10 patients, and an abdominal and pelvic ultrasound was utilised to help locate the afflicted ureter. The patient had transvesical ureteral stent insertion. The stent was removed after two weeks. No wetness in the 10 patients.In the middle of today's complicated health care system, we must continuously remind ourselves of the common develops after a caesarean section and a well-known and simple diagnostic technique management in resource-poor communities

Occurrence of Fasciola (Digenea: Fasciolidae) Species in Livestock, Wildlife and Humans, and the Geographical Distribution of Their Intermediate Hosts in South Africa-A Scoping Review.

This review was conducted to provide an update on the status of the occurrence of Fasciola species in livestock, wildlife and humans, and the geographical distribution of snail intermediate host (IH) species in South Africa. The literature search was conducted on four electronic databases using the Boolean operators in combination with predetermined search terms for thematic analysis. Results showed that Fasciola species have been reported in six out of nine provinces of South Africa in the last six decades (1960–2021), with both F. hepatica and F. gigantica infecting vertebrate hosts and F. hepatica and Fasciola spp infecting humans. Results also showed that most studies relied on morphological identification of eggs and flukes without molecular confirmation, which might have led to the misidentification of specimens, especially when immature. Fasciola hepatica has been documented in Limpopo, Mpumalanga, and KwaZulu-Natal provinces. The occurrences of Galba truncatula as the probable snail IH for F. hepatica in the three provinces has been documented while Pseudosuccinea columella has only been documented in Mpumalanga and KwaZulu-Natal provinces. The occurrence of F. gigantica to date has been reported in Mpumalanga and KwaZulu-Natal provinces, with overlapping distribution with F. hepatica. Radix natalensis, the main IH of F. gigantica has been documented in all the three provinces, while the two alien Radix species (R. auricularia and R. rubiginosa) were documented in KwaZulu-Natal province and have been implicated elsewhere with the transmission of F. gigantica. The presence of Fasciola spp eggs and antibodies in humans were documented in the Eastern Cape and the Western Cape provinces, where both P. columella and G. truncatula are known to be present. The prevalence of Fasciola spp infection in livestock ranged from 9.1 to 37.67 %, with an estimated annual financial loss ranging from R44930.26-129901 in cattle production in the Eastern Cape province of South Africa. This review reaffirms the scarcity of information on the occurrence and burden of fasciolosis in South Africa, and further highlights the importance of future research covering all provinces of the country and assessing the public health significance of the disease in resource-poor livestock communities in the areas where the parasite is endemic.

Strengthening the university third mission through building community capabilities alongside university capabilities

Abstract Growing concern about widening inequalities and a deepening sustainability crisis has prompted new directions and conceptions of the third mission of universities. This paper contributes by drawing attention to the capabilities required to enable mutually-beneficial engagement with community-based partners in resource-poor local settings to not only co-produce scholarly outputs but also co-produce development outcomes. Based on in-depth case study research of three resource-poor communities in South Africa, we identify a set of capabilities that communities need to possess to seek out and engage with suitable partners and to co-learn through their engagement activities. We propose a new framework, a community ‘dynamic interactive capabilities’ (von Tunzelmann and Wang, 2003) framework, extending the concept from firms and universities to local community settings. The framework prompts a fresh way of thinking about the third mission, whereby universities orient their engaged teaching and research activities in ways co-evolved with the capabilities of community partners.

Community Eye Care Outreaches through Collaborations with Community-Based Organisations in Resource-Poor Settings in Ilorin, Nigeria.

The access to universal eye health is still poor in many developing countries. There are various initiatives to address this problem, but the initiatives are majorly under the support of external funding. This study reports community outreaches supported by community-based organisations over a 7-year period in resource-poor settings in Ilorin, Kwara State, Nigeria. This study aims to describe the processes/procedures, output, and funding of eye care services provided in the rural communities over a 7-year period. The study seeks to present the process, demographical profiles, disease pattern, challenges, and recommendation in finding the core area of development to improving eye care services for these communities as well. The setting of this research work is 65 rural communities around the Ilorin metropolis of Kwara State, Nigeria. The design of the study is a retrospective review. This is a descriptive study of 7-year community eye outreaches in Ilorin, Nigeria. Data were analysed with IBM-Statistical Package for Social Sciences (SPSS-20). A total of 65 communities with 235 visits were carried out between the years 2013 and 2019, with a total of 13,661 persons screened. The major eye diseases seen were refractive errors, allergic conjunctivitis, cataract, and pterygium. Common surgical eye problems were cataract, pterygium, and glaucoma. Community-based organisation direct financial support built up from USD 855 in 2013 and totalled USD 27,250 in 2019. Community-based organisation funding is an alternative and useful means of meeting the unmet needs of eye care in resource-poor communities. Subsidised care was provided to community-sourced patients due to support by local community-based organisations. This subsidy assisted in reaching the outreach numerical goal. However, it was still inadequate to meet the total needs as seen by the lower number of clinical care and surgeries rendered against the total numbers identified. To achieve sustainable and wider coverage of care, a combination of local source and external funding is required. This study shows that community eye care programme can be supported by local or indigenous sponsors in a sustainable manner, thereby contributing considerably to addressing prevalent cases of avoidable blindness.

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.