Western Cape Province Research Articles

Emergence and expansion of carbapenem resistant enterobacterales in the Western Cape Province, South Africa.

Carbapenem resistant Enterobacterales (CRE) have become established as leading pathogens in South African healthcare facilities. The aim of this study is to describe the epidemiology of CRE carriage and clinical infection episodes at healthcare facilities in the Western Cape Province of South Africa (2016-2020), and identify factors associated with mortality in CRE infected patients. We used routine data from the Provincial Health Data Centre to track the emergence of CRE in healthcare facilities in the Western Cape Province of South Africa. We included all CRE episodes (clinical and carriage) at Western Cape hospitals (including day and inpatients) from 2016 to 2020 to determine the distribution of CRE, patient demographics and antibiotic resistance phenotypes. Logistic regression was performed to identify factors associated with mortality from clinical CRE episodes. 2242 CRE episodes (1580 [70.5%] clinical and 662 [29.5%] carriage) were identified. From these, 2281 CRE isolates were identified, with Klebsiella species predominating (1644, 72.1%). Affected patients had a median age of 31 (IQR 0-52) years, and 1167 (52.0%) were male. Most CRE episodes were recorded in central hospitals (70.0%, p < 0.001). Where outcome data was available, crude in-hospital mortality rates were 26.9% (371/1379) for CRE clinical episodes versus 6.4% (41/640) for CRE carriage episodes (p < 0.001). Factors that showed a statistically significant association with in-hospital mortality were female sex [adjusted odd ratio (aOR) 1.40 (95% confidence interval (CI) 1.09-1.560)], adult patients [aOR 1.76 (95% CI 1.20-2.57)], CRE isolation from a sterile specimen [aOR 0.41 (95% CI 0.32-0.53)], and >3 days between hospital admission and specimen collection [aOR 1.56 (95% CI 1.11-2.18)]. CRE episodes at Western Cape healthcare facilities are concentrated at tertiary hospitals, with high case fatality rates in patients with clinical CRE episodes. Infection control interventions must be strengthened to reduce transmission of CRE, and to reduce infection risks.

The impact of Nassella trichotoma (Nees) Hack. ex Arechav. on plant diversity, richness and soil properties in South Africa

Nassella trichotoma (Poaceae) is a highly invasive South American grass that is invading montane grasslands in the Eastern and Western Cape provinces of South Africa. Although N. trichotoma has been recognised as a major problem in these mountains for decades, the primary concern has been on impacts on rangeland productivity and management, while the impacts of invasions on plant biodiversity have not been considered. To understand the impact of N. trichotoma on local plant biodiversity, 81 pairs of plots (total of 162 plots) were laid out in the Sneeuberg and Eastern Cape Drakensberg mountains, Eastern Cape, in March 2020 and March 2021. At each site plots were located in grassland invaded by N. trichotoma and in nearby uninvaded grassland (control). A total of 20 N. trichotoma patches were sampled with two to four plot pairs per site. All vascular plant species were recorded in all plots, the cover abundance of each species per plot was visually estimated, and the topsoil was sampled and analysed for differences in nutrient and physical factors between invaded and uninvaded plots. Plant species diversity was 24 % higher in uninvaded areas, and the native grasses Pentameris airoides (Χ2 = 4.93, d.f. = 1, p < 0.01), Tenaxia disticha (Χ2 = 5.51, d.f. = 1, p < 0.01), and Themeda triandra (Χ2 = 9.28, d.f. = 1, p < 0.001) were significantly less abundant in invaded plots. Uninvaded areas had greater native species diversity (65 species) and fewer alien species (3) than invaded areas (47 and 9 respectively). Of the 18 soil variables measured, the following were significantly higher in invaded areas than uninvaded areas: boron (23 %), calcium (18 %), phosphorous (58 %), silt (10 %), total cations (12 %), and zinc (68 %). This suggest that N. trichotoma alters soil nutrients. The results indicate that N. trichotoma is a powerful driver of native biodiversity erosion in these montane grasslands and should be a cause for major concern by landowners and government.

Molecular characterisation of hepatitis A in the Western Cape province, South Africa in 2023

In 2023, passive laboratory-based surveillance showed an increase in hepatitis A virus (HAV) infection. We investigated hepatitis A incidence using the notifiable medical condition surveillance system (NMCSS) data and molecularly characterised positive blood samples from the Western Cape province for 2023. All HAV IgM seropositive cases from the NMCSS from 1 January to 31 October 2023 in South Africa were investigated. HAV RNA from blood samples that had tested positive for HAV IgM from Western Cape was amplified in the VP1/P2B junction and sequenced (3500Xl Genetic Analyser). Sequences were assembled, aligned (Sequencher) and analysed (Aliview 1.27 and MEGA11). Statistical analysis was performed using Excel and the CuSum2 Threshold to determine suspected outbreaks. In 2023, the incidence of HAV IgM was 6.28/100,000 in South Africa, with the highest incidence in Western Cape province (15.86/100,000). Children aged 5 to 14 years were affected the most in the Western Cape. The positive cases in the Western Cape were above the CuSum2 threshold from January to May 2023, with the highest incidence observed in the City of Cape Town Metropolitan (14.8/100,000). Genotyping was successfully performed on 92.7% (139/150) of serum samples, for which the IB sub-genotype was detected. Three primary mutations R63K, R71S and M104I were observed in more than 49% of the samples. Most of the samples sequenced belonged to patients residing in areas close to each other within the City of Cape Town Southern, Western, and Mitchells Plain sub-districts. The CuSum2 threshold method allowed the identification of suspected HAV outbreaks in the districts within the Western Cape in 2023 while genotyping identified clusters of sub-genotype IB. Genotyping could assist with determining the common source of infection during an outbreak, especially if coupled with epidemiological and geographical data. Further active surveillance can assist in investigating the HAV risk factors for targeted public health responses.

Prevalence and genetic diversity of Bartonella spp. in wild small mammals from South Africa.

Bartonella spp. are intracellular bacteria associated with several re-emerging human diseases. Small mammals play a significant role in the maintenance and spread of Bartonella spp. Despite the high small mammal biodiversity in South Africa, there is limited epidemiological information regarding Bartonella spp. in these mammals. The main aim of this study was to determine the prevalence and genetic diversity of Bartonella spp. from wild small mammals from 15 localities in 8 provinces of South Africa. Small mammals (n = 183) were trapped in the Eastern Cape, Free State, Gauteng, Limpopo, Mpumalanga, Northern Cape, North West, and Western Cape provinces of South Africa between 2010 and 2018. Heart, kidney, liver, lung, and spleen were harvested for Bartonella DNA screening, and prevalence was determined based on the PCR amplification of partial fragments of the 16S-23S rRNA intergenic spacer (ITS) region, gltA, and rpoB genes. Bartonella DNA was detected in Aethomys chrysophilus, Aethomys ineptus, Gerbillurus spp., Lemniscomys rosalia, Mastomys coucha, Micaelamys namaquensis, Rhabdomys pumilio, and Thallomys paedulcus. An overall prevalence of 16.9% (31/183, 95% CI: 12.2%-23%) was observed. Bartonella elizabethae, Bartonella grahamii, and Bartonella tribocorum were the zoonotic species identified, while the remaining sequences were aligned to uncultured Bartonella spp. with unknown zoonotic potential. Phylogenetic analyses confirmed five distinct Bartonella lineages (I-V), with lineage IV displaying strong M. coucha host specificity. Our results confirm that South African wild small mammals are natural reservoirs of a diverse assemblage of Bartonella spp., including some zoonotic species with high genetic diversity, although prevalence was relatively low.IMPORTANCESmall mammals play a significant role in the maintenance and spread of zoonotic pathogens such as Bartonella spp. Despite the high small mammal biodiversity in southern Africa including South Africa, there is limited epidemiological information regarding Bartonella spp. in these mammals across the country. Results from our study showed the liver and spleen had the highest positive cases for Bartonella spp. DNA among the tested organs. Bartonella elizabethae, B. grahamii, and B. tribocorum were the three zoonotic species identified and five distinct Bartonella lineages (I-V) were confirmed through phylogenetic analyses. To the best of our knowledge, this study presents the first extensive nuclear diversity investigation of Bartonella spp. in South African small mammals in South Africa.

Performance comparison of three commercial multiplex molecular panels for respiratory viruses at a South African academic hospital.

Respiratory infections are a major contributor to hospital admissions. Identification of respiratory pathogens by means of conventional culture and serology methods remains challenging. Multiplex molecular assays are an appealing alternative that endeavours to be rapid, more accurate and less arduous. The study aimed to compare the clinical performance of three commercial multiplex molecular assays for respiratory viruses. Forty-eight respiratory specimens obtained from patients at Tygerberg Hospital in the Western Cape province of South Africa were studied. These specimens were collected between May 2020 and August 2020. The results of the Seegene Anyplex™ II RV16, FilmArray® Respiratory 2.1 plus Panel (FARP), and QIAstat-Dx® Respiratory SARS-CoV-2 Panel (QRP) were analysed based on the overlapping targets. A composite reference standard was applied to provide a standard reference for comparison. The overall sensitivity of the Seegene Anyplex™ II RV16 was 96.6% (57/59), the FARP 98.2% (56/57) and the QRP 80.7% (46/57). The overall specificities were 99.8% (660/661), 99.0% (704/711) and 99.7% (709/711), respectively. The QRP failed to detect coronaviruses and parainfluenza viruses in 41.7% (5/12) and 28.6% (4/14) of positive specimens, respectively, while the FARP produced the lowest target specificity of 88.4% (38/43) for rhinovirus/enterovirus. The overall specificity of all three platforms was comparable; however, the sensitivity of the QRP was inferior to that of the ARV and FARP. This study adds to the body of performance characteristics described for respiratory multiplex panels, especially in the African context where molecular diagnostics for infectious diseases are gaining momentum.

Bread wheat cultivar Popo harbors QTLs for seedling and adult plant resistance to leaf rust in South African and Argentine environments

Leaf rust, caused by the fungus Puccinia triticina Eriks (Pt), is a destructive disease affecting wheat (Triticum aestivum L.) production in many countries, and a serious threat to food security. As a result, several breeding programs have included leaf rust resistance as an important trait. The discovery and identification of new resistance genes that could aid in incorporating durable or long-lasting leaf rust resistance into wheat is fundamental in these breeding programs. The present study aimed to identify quantitative trait loci (QTLs) for leaf rust resistance in 127 recombinant inbred lines (RIL) developed from the cross between the resistant wheat cultivar Popo and the susceptible cultivar Kariega. The RIL population and parental lines were phenotyped for leaf rust infection type and severity at seedling and adult plant stage, respectively. The former in the greenhouse (in Argentina) and the latter in multiple field test environments comprising 3 locations in South Africa (in Tygerhoek in the Western Cape Province during the 2014, 2015, 2017 and 2018 cropping seasons; Clarens during 2014, 2016 and 2017 cropping seasons and in Bethlehem in the Free State Province during 2017 cropping season) and in 1 location in Argentina (during the 2017 and 2018 cropping seasons in Marcos Juárez, Córdoba Province). The population was genotyped using genotyping-by-sequencing. A total of 12,080 silicoDArT and 2,669 SNP markers were used for QTL analysis. In total, 25 putative QTLs for resistance to leaf rust at seedling and adult plant stages were identified, including 5 QTLs for seedling and 20 QTLs for adult plant resistance (APR). Interestingly, both Popo and Kariega contributed with alleles for resistance. Significant loci for reducing leaf rust infection at seedling stage were designated QLr.arc-1A, QLr.arc-2B, QLr.arc-5B, QLr.arc-6A and QLr.arc-6D. Three minor QTLs derived from Popo designated as QLr.arc-1B1, QLr.arc-2D and QLr.arc-3D were also detected from the field tests, explaining 5–10%, 10–16% and 5–7% of the phenotypic variance, respectively. The identified QTLs and their closely linked silicoDArT and SNP-based markers can be used for fine mapping and candidate gene discovery in wheat breeding programs targeting durable leaf rust resistance.

Older persons' knowledge of HIV and AIDS prevention in a province of South Africa.

Population ageing and access to antiretroviral therapy have resulted in an increase in the proportion of older people living with human immunodeficiency virus (HIV). However, scant knowledge is available to inform the design of educational programmes to target these persons in low- and middle-income countries. This study aimed to examine how persons aged ≥ 50 years view their risk of contracting HIV, and the extent to which they are supported in preventing infection and are impacted by the HIV or acquired immune deficiency syndrome (AIDS) epidemic. Rural sites in the Western Cape Province of South Africa. This study followed a qualitative design. Two focus group discussions with persons aged ≥ 50 years and interviews with two key informants were conducted at seniors' centres. Discussions were digitally audio recorded and the recordings were transcribed, and data were thematically analysed. Overall, awareness of the risk of older persons contracting HIV infection in this population was poor. Stigmatisation of the disease in the community and at health care facilities affected individuals' willingness to be tested for the virus and/or to disclose their status, if positive. Participants viewed HIV and AIDS education programmes as focussed on the youth and educational sessions for large groups were not helpful in stemming the epidemic. Dissemination of information on older persons' vulnerability to the disease, and education on HIV and AIDS tailored for and targeted at this age group have been relatively neglected.Contribution:Educational programmes on HIV, as well as productive channels and platforms to target older populations, particularly those with a low health literacy level are required.

Cultivation of honeybush (Cyclopia spp.) in neo-colonial and multispecies landscapes of South Africa

The indigenous wild plants of Southern Africa are intertwined with human cultures, histories and livelihoods. By focusing on commercial cultivation of a wild plant, honeybush (Cyclopia spp.), an indigenous plant that is endemic to parts of South Africa, we discuss changing colonial relations of domination and alienation affecting its use by local communities. We draw from an interdisciplinary study of honeybush conducted in the Western Cape and Eastern Cape provinces of South Africa, which included archival research, life history interviews, participant observation and a review of honeybush cultivation science. Anna Tsing’s notion of non-scalability and a multispecies critique of plant domestication guides our analysis of the changing relations and approaches to honeybush use. We show the impact these changes exert on human and human-non-human relations. We conclude that the persistence of scalable projects in the commercial use of honeybush sustains and reconfigures relations that strengthen the alienation of (certain) humans from nature. Our interdisciplinary research highlights how historical violence continues to be subsumed in plant domestication and commercialisation.

Evaluating changes in flood frequency due to climate change in the Western Cape, South Africa

This study assesses the impact of climate change on flood frequency across seven sites in the Western Cape province of South Africa. The calibrated Water Resources Simulation Model (WRSM)/Pitman hydrological model was run using precipitation inputs from two representative concentration pathways (RCP) scenarios (RCP 4.5 and 8.5) using a combination of eight global circulatory models (GCM) for the two periods (2030–2060 and 2070–2100). GCMs were statistically downscaled using the delta change (DC), linear scaling (LS) and quantile delta mapping (QDM) approaches. Average daily discharge was estimated from each downscaled daily precipitation dataset using the Pitman/WRSM model with the Fuller and Sangal estimation methods used to calculate daily instantaneous peak flows. Flood frequency curves (FFC) were generated using the annual maximum series (AMS) for the GCM ensemble mean and individual GCMs for the return periods between 2 and 100 years. FFCs generated based on LS and QDM downscaling methods were aligned for the GCM ensemble mean in terms of the direction of FFCs. Further analysis was conducted using outputs based on the QDM approach, given its suitability in projecting peak flows. Under this method, both Fuller and Sangal FFCs exhibited a decreasing trend across the Jonkershoek and Little Berg River sites; however, estimated quantiles for low-probability events were higher under the Fuller method. This study noted the variation in FFCs from individual GCMs compared to the FFC representing the GCM ensemble mean. Further research on climate change flood frequency analysis (FFA) in South Africa should incorporate other advanced downscaling and instantaneous peak flow estimation (IPF) methods.

Exploring the wound healing potential of Lobostemon fruticosus using in vitro and in vivo bioassays

Ethnopharmacological relevanceLobostemon fruticosus (L.) H.Buek is a perennial and woody shrub of the Boraginaceae family, found in the Cape region of South Africa. The leaves and twigs are used to treat dermatological conditions such as wounds, burns, ringworm, erysipelas and eczema. Anti-inflammatory, antibacterial, antiviral and anti-proliferative activities of L. fruticosus have been reported. However, there is a void in research which reports on the wound healing properties of this plant. Aim of the studyAligned with the traditional use of L. fruticosus, our study aimed to use in vitro and in vivo bioassays to confirm the wound healing potential of the plant. Materials and methodsAn aqueous methanol extract (80% v/v) of L. fruticosus was prepared using a sample collected from the Western Cape Province of South Africa and chromatographically profiled by ultra-performance liquid chromatography coupled to mass spectrometry (UPLC-MS). The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cytotoxicity assay was performed to determine the non-toxic concentrations of the extract for subsequent use in the in vitro scratch assay. Both the human keratinocyte (HaCaT) and fibroblast (BJ-5ta) cell lines were employed in the in vitro scratch assay. The in vivo caudal fin amputation assay was used to assess the wound healing potential of L. fruticosus, by monitoring fin regeneration in zebrafish larvae treated with the plant extract at various concentrations. ResultsSix major compounds were tentatively identified in the L. fruticosus extract namely; globoidnan A, globoidnan B, rutin, rabdosiin, sagerinic acid and rosmarinic acid. The potentially toxic pyrrolizidine alkaloids were also identified and quantitatively confirmed to be present at a low concentration of 119.58 ppm (m/m). Treatment of HaCaT and BJ-5ta cells with the plant extract in the scratch assay resulted in an increase in cell migration, which translates to accelerated wound closure. After 24 hr treatment with 100 μg/mL of extract, wound closure was recorded to be 91.1 ± 5.7% and 94.1 ± 1.3% for the HaCaT and BJ-5ta cells, respectively, while the untreated (medium) controls showed 72.3 ± 3.3% and 73.0 ± 4.3% for the two cell lines, respectively. Complete wound closure was observed between 24 and 36 hr, while the untreated control group did not achieve 100% wound closure by the end of the observation period (48 hr). In vivo, the crude extract at 100 μg/mL accelerated zebrafish caudal fin regeneration achieving 100.5 ± 3.8% regeneration compared to 68.3 ± 6.6% in the untreated control at two days post amputation. ConclusionsThe study affirms the wound healing properties, as well as low toxicity of L. fruticosus using both in vitro and in vivo assays, which supports the traditional medicinal use. Other in vitro assays that target different mechanisms involved in wound healing should be investigated to support the current findings.

The Retrospective Implementation of Standardized In Utero HIV Exposure Definitions Using Routinely Collected Public Sector Data Across the Western Cape Province, South Africa.

Using the Data Evaluation and Preparation for HIV-Exposed Uninfected Child Cohorts project's standardized child HIV exposure definitions, 64%, 64% and 90% of children exposed to HIV in utero could be classified as HIV-uninfected with moderate or high certainty at the ages of 1 and 3 years and at the time of first infectious disease hospitalization, respectively. These definitions can be applied retrospectively to routine datasets with linked mother-child data.

Whole Genome Sequence Analysis of Brucella spp. from Human, Livestock, and Wildlife in South Africa

Brucellosis is an economically important zoonotic disease affecting humans, livestock, and wildlife health globally and especially in Africa. Brucella abortus and B. melitensis have been isolated from human, livestock (cattle and goat), and wildlife (sable) in South Africa (SA) but with little knowledge of the population genomic structure of this pathogen in SA. As whole genome sequencing can assist to differentiate and trace the origin of outbreaks of Brucella spp. strains, the whole genomes of retrospective isolates (n = 19) from previous studies were sequenced. Sequences were analysed using average nucleotide identity (ANI), pangenomics, and whole genome single nucleotide polymorphism (wgSNP) to trace the geographical origin of cases of brucellosis circulating in human, cattle, goats, and sable from different provinces in SA. Pangenomics analysis of B. melitensis (n = 69) and B. abortus (n = 56) was conducted with 19 strains that included B. abortus from cattle (n = 3) and B. melitensis from a human (n = 1), cattle (n = 1), goat (n = 1), Rev1 vaccine strain (n = 1), and sable (n = 12). Pangenomics analysis of B. melitensis genomes, highlighted shared genes, that include 10 hypothetical proteins and genes that encodes for acetyl-coenzyme A synthetase (acs), and acylamidase (aam) amongst the sable genomes. The wgSNP analysis confirmed the B. melitensis isolated from human was more closely related to the goat from the Western Cape Province from the same outbreak than the B. melitensis cattle sample from different cases in the Gauteng Province. The B. melitensis sable strains could be distinguished from the African lineage, constituting their own African sub-clade. The sequenced B. abortus strains clustered in the C2 lineage that is closely related to the isolates from Mozambique and Zimbabwe. This study identified genetically diverse Brucella spp. among various hosts in SA. This study expands the limited known knowledge regarding the presence of B. melitensis in livestock and humans in SA, further building a foundation for future research on the distribution of the Brucella spp. worldwide and its evolutionary background.

Provider perspectives on adolescent access to contraception in South Africa.

Poor access to contraception influences adolescent health outcomes and may lead to sexual and reproductive health challenges. Unmet sexual and reproductive health should contribute to unplanned adolescent pregnancies, sexually transmitted infections, and other conditions. Therefore, it is crucial to enable adolescents to access appropriate contraceptive methods easily. This study explored factors influencing adolescents' access to contraceptive methods from the perspective of primary healthcare providers in South Africa. This study was conducted in two health districts of the Western Cape province in South Africa: the City of Cape Town Metropolitan Municipality and the West Coast district. Using a qualitative research design, in-depth semi-structured interviews were conducted with 24 healthcare providers who work in primary healthcare clinics. Subsequently, the interviews were transcribed and verified for errors. Braun and Clarke's thematic analysis model guided the data analysis using ATLAS.ti software (version 22). The study adhered to the consolidated criteria for reporting qualitative studies checklist for qualitative research. Four themes emerged through the data analysis: (1) personal influences, (2) community-level influences, (3) health system influences, and (4) policy-level influences. Representative quotations were used to illustrate the themes and sub-themes. Adolescence is shaped by various influences that affect adolescents' ability to access contraception. These factors include their awareness of contraception, social environment, provider biases and school policies. Understanding these influences is crucial for addressing unintended pregnancies and promoting sexual and reproductive health among this age group.Contribution:This study highlights strategies that facilitate and hinder adolescents' access to contraception.

Adolescent girls and young women’s (AGYW) access to and use of contraception services in Cape Town: perspectives from AGYW and health care providers

BackgroundAccess and use of contraception services by adolescent girls and young women (AGYW) remains suboptimal, exposing AGYW to early and often unexpected pregnancy. Unexpected pregnancies are a public health concern, associated with poor neonatal and maternal health outcomes, as well as school dropout, which may result in economic hardships. This study aimed to explore (a) AGYW perceptions and experiences of receiving contraception services from health care providers and (b) health care providers’ perceptions and experiences of providing contraception services to AGYW.MethodsData were collected through semi-structured individual interviews with AGYW aged 15–24 years old and health care providers working in eight health care facilities around the Cape Town metropolitan area, in South Africa’s Western Cape Province. Thematic analysis was used to analyse the data.ResultsAGYW and health care providers voiced varying, and often contrasting, perceptions of some of the barriers that hinder AGYW’s access to contraception services. AGYW indicated that provider-imposed rules about when to access contraceptive services hindered access, while health care providers felt that these rules were necessary for coordinating their work. In addition, AGYW highlighted health care providers’ hostile attitudes towards them as an important factor discouraging access. On the contrary, health care providers did not think that their attitudes hampered AGYW’s access to and use of contraception services, instead they emphasised that challenges at the health system level were a major issue, which they feel they have little control over. Such challenges made health care providers’ work unpleasant and frustrating, impacting on their work approach and how they receive and offer services to AGYW.ConclusionThe expectation of negative attitudes from health care providers continues to be at the centre of AGYW discouragement towards accessing contraception services. System challenges are among some of the key drivers of health care provider’s hostile attitudes, posing challenges to the efficient provision of services. In order to improve AGYW’s access to and use of contraception services, and subsequently achieve the country’s SDGs, conscious efforts need to be directed towards improving the workload and working conditions of health care providers.

Neurological manifestations of Varicella zoster infection: A case series

Introduction: Varicella zoster virus (VZV) causes infection of the central nervous system, which manifests as various neurological syndromes. In this case series, we discuss three different clinical presentations of VZV reactivation (herpes zoster). The main clinical feature of herpes zoster is a pruritic vesicular rash, present in a dermatomal distribution, which occurs after reactivation of the virus because of immunosuppression.Patients presentation: We report on three individual cases of complicated herpes zoster that resulted in various neurological pathologies. The patients described in this case series each received a lumbar puncture with cerebrospinal fluid analysis, which showed a positive varicella zoster polymerase chain reaction test (VZV PCR).Management and outcome: All three patients received intravenous acyclovir as their core component of treatment. In addition to this, some received other adjunctive treatments, mainly corticosteroids. Two patients achieved disease resolution while one patient demised.Conclusion: The case series highlights the various ways in which VZV can affect the central nervous system (CNS) such as meningitis, encephalitis, myelitis and arteritis.Contribution: This is a brief overview of the clinical manifestations of VZV affecting the CNS in patients presenting to a regional hospital within the Western Cape province in South Africa.

Comparative analysis of the predictive capabilities of some machine learning models: A case study using wind speed data

The widespread use of fossil fuels for global energy production significantly contributes to global warming. This study presents a comparative analysis of various machine learning models, which are the long short-term memory (LSTM) network, support vector regression (SVR), and gradient boosting method (GBM). Gaussian process regression (GPR) is a benchmark model across different forecasting horizons. The study uses South African wind speed data from 1 January 2018 to 31 December 2021, sourced from the Western Cape province. The dataset underwent preprocessing, and diverse feature selection techniques were implemented to enhance model accuracy. Performance evaluation of the models was done using mean absolute error (MAE), root mean squared error (RMSE), and mean absolute scaled error (MASE). Results indicate that SVR exhibits superior accuracy to other models for two distinct forecast horizons (h = 670 and h = 1339), respectively. Additionally, GPR surpasses other models for the forecasting horizon h = 224. This study provides insights into the comparative strengths and weaknesses of different machine learning models for wind speed prediction, which could be useful in selecting an appropriate model for future applications in renewable energy and weather forecasting. Potential areas for future research include improving prediction accuracy via ensemble deep learning algorithms and incorporating additional meteorological variables. Moreover, investigating temporal dynamics, broadening geographical coverage and integrating uncertainty quantification methods can improve wind speed prediction, thereby facilitating more effective renewable energy planning and decision-making processes

&lt;p&gt;Livelihood Impacts of Drought: Experiences from Households and Business Organizations in Western Cape Province of South Africa&lt;/p&gt;

Drought is a recurring natural phenomenon with significant socio-economic and environmental impacts across South Africa. This research investigates the livelihood impacts of drought on households and organizations in the Western Cape Province of South Africa, utilizing a secondary dataset collected by the Human Sciences Research Council of South Africa. Descriptive statistics were used to describe and explore the dataset. Likewise, heterogeneous choice modeling was applied to investigate the factors influencing the levels of livelihoods impacts of drought among household and organizations. The findings underscored households’ greater vulnerability to drought compared to organizations across all the levels of drought impacts. Many households reported considerable and major impacts, which were largely due to differentials in adaptive capacity. While awareness of the drought was widespread, perception varied regarding the government’s effectiveness in managing the crisis, as less than half of the population of organizations (43.7%) and households (42.1%) have strong belief that the government was very effective in the management of drought disaster, while 30.9% and 34.6% of the organizations and households respectively, believed that the government was not effective enough with the management of drought crisis. Hygiene, chores, and gardening suffered the most among households, whereas disruption of business and financial burdens were predominant for organizations. Factors that significantly influenced the levels of drought impacts include age, institutional engagement of water restrictions, livelihood areas impacted by drought, and perceptions on water consumption rate. The study recommends heightened awareness of water conservation, compliance with restrictions, investment in infrastructure, and embracing community-based adaptation and disaster risk reduction initiatives. For organizations, emergency response plans, business continuity planning, and stakeholder engagement will be helpful to bolster resilience to drought.

Engaging stakeholders to address a complex water resource management issue in the Western Cape, South Africa

Engaging water users when developing water management plans is increasingly being embraced by a wide range of scientists in the water sector as imperative for dealing with present-day water resources challenges. However, the complexity presented by unique catchment situations makes it difficult to prescribe a ‘one size fits all’ solution to localised water resource challenges. South Africa is well-known for its population heterogeneity, which spreads into catchments, layering complexity in terms of water user types, needs and interests. This research presents a novel conjunctive use of classical and newly developed tools within a stakeholder engagement framework. This application of a suite of tools responds to the complex conflict of water user needs and interests in the Koue Bokkeveld catchment in the Western Cape Province of South Africa. We implement the Adaptive Planning Process, and the Actors, Resources, Dynamics, and Interactions approaches to unite conflicting stakeholders and develop a shared vision as the foundation for co-developing and negotiating a shared water management plan. We present the outcomes of a series of participatory workshops in which stakeholders developed a shared catchment vision. Stakeholders united around the vision and actively engaged in participatory Agent-based Model co-development with the research team. Increased attendance and active participation in the latter workshops demonstrate a positive progression in the engagement process. Outcomes of the stakeholder feedback evaluation validate increased participant satisfaction with the process. We then reflect on the practicalities of stakeholder engagement based on our experience. Learnings from this conjunctive application of approaches suggest that providing a conducive engagement platform, facilitation, and appropriate tools can enable conflicting water users to develop shared solutions collaboratively.

Investigating the standard design and production procedure of heritage mortars for compatible and durable masonry restoration

Historic buildings ensure generational knowledge of past events, milestones, construction developments and evolution of materials, architectural designs, and practices throughout the centuries. It is indisputable that heritage buildings' survival against deterioration factors has proven the use of durable materials for their construction. However, they suffer inevitable decay due to ageing. Therefore, restoring the monuments to their original appearance and strength is always necessary for long-term survival. This paper discusses solutions for the design and development methods of new compatible restoration mortars for the architectural heritage, covering four significant aspects, namely: i) visual analysis of the heritage building in question, ii) experimental analysis of the original mortar samples for their physical, mineralogical and chemical properties, iii) characterization of the potential raw materials (available in the study area) that are close to the original, and iv) assessment of the new mortar durability. The mortars collected from the Castle of Good Hope, an important and ancient colonial edifice in the Western Cape Province (South Africa), were earth (samples SK7 to SK9) and hydraulic lime-based (SK1 to SK6), with 21–38 % porosity. The raw materials used on this monument include feldspar aggregates, possibly from the West Coast (Cape Town) and hydraulic lime for SK1, SK3 and SK5 mortars. For the restoration of the lime mortars (SK1, SK3 and, SK5), a hydrated lime-based mortar with a binder-to-aggregate ratio of 1:3, made of west coast sea sand and 5 % seashell additives, with a porosity of 24 %, has proved to be the most durable. The aesthetics for all the restoration mortars M1 to M9 is difficult to achieve considering the original material ageing factor, thus, the use of color-enhancing pigments is recommended.

Tuberculin skin test surveys and the Annual Risk of Tuberculous Infection in school children in Northern KwaZulu-Natal.

Tuberculin skin test surveys in primary school children can be used to quantify Mycobacterium tuberculosis transmission at community level. KwaZulu-Natal province, South Africa, is home to 11.5 million people and suffers a burden of tuberculosis disease that is among the highest in the world. The last tuberculin survey in the province was undertaken in 1979. We performed a tuberculin skin test survey nested within a demographic and health household surveillance programme in Northern KwaZulu-Natal. We enrolled children aged between six and eight years of age attending primary schools in this community. Mixture analysis was used to determine tuberculin skin test thresholds and the Annual Risk of Tuberculous Infection derived from age at testing and infection prevalence. The Community Infection Ratio, a measure of the relative importance of within-household and community transmission, was calculated from data on tuberculin positivity disaggregated by household tuberculosis contact. Between June and December 2013, we obtained tuberculin skin test results on 1240 children. Mixture analysis proved unstable, suggesting two potential thresholds for test positivity. Using a threshold of ≥10mm or treating all non zero reactions as positive yielded estimates of the Annual Risk of Tuberculous Infection of 1.7% (1.4-2.1%) or 2.4% (2.0-3.0%). Using the same thresholds and including children reported to be receiving TB treatment as cases, resulted in estimates of 2.0% (1.6-2.5%) or 2.7% (2.2-3.3%). The Community Infection Ratio was 0.58 (0.33-1.01). The force of infection in this community is lower than that observed in Western Cape province, South Africa, but higher than that observed in community settings in most other parts of the world. Children in this community are commonly infected with Mycobacterium tuberculosis outside the home. Interventions to interrupt transmission are urgently needed.