COVID-19 vaccine hesitancy in KwaZulu-Natal, South Africa: A survey of unvaccinated adults

Background: Concerns and misconceptions surrounding coronavirus disease 2019 (COVID-19) vaccines may account for vaccine hesitancy and low uptake. Aim: To determine prevalence of COVID-19 vaccine hesitancy, vaccine-related misconceptions, and predictors of vaccine hesitancy among South Africans. Setting: Community setting in five districts in KwaZulu- Natal province. Methods: Between August 20, 2021, and September 27, 2021, we conducted a cross-sectional survey, interviewing 300 unvaccinated adults amid the national vaccination campaign. Predictors of hesitancy were identified through multivariable logistic regression analysis. Results: Participants had a median age of 29 years (IQR: 23­39), 86.7% were Black African, 63.2% were male, 53.3% resided in rural communities, and 59.3% (95% CI: 53.8% ­ 64.9%) were classified as vaccine hesitant. The primary reason for not vaccinating was a lack of trust in the vaccine (62.1%). Factors associated with reduced vaccine hesitancy included age (participants aged 35­49 years: OR: 0.28, 95% CI: 0.18­0.64, p = 0.003; participants over 50 years: OR: 0.18, 95% CI: 0.07­0.47, p = 0.0004), previous COVID-19 infection (OR: 0.31, 95% CI: 0.11­0.87, p = 0.03), and receiving vaccine information from healthcare workers (OR: 0.32, 95% CI: 0.10­1.0, p = 0.05). Unemployed (OR: 2.14, 95% CI: 1.1­4.2, p = 0.03) and self-employed individuals (OR: 2.98, 95% CI: 1.27­7.02, p = 0.01) were more likely to be vaccine hesitant. Conclusion: COVID-19 vaccine hesitancy rates are high in KwaZulu-Natal. Uptake could be enhanced by healthcare workers leading information campaigns with messages targeting younger individuals, the unemployed, and the self-employed. Contribution: This survey provides evidence to improve COVID-19 vaccination uptake in South Africa.

Psychological distress among South African healthcare workers during the COVID-19 pandemic

Background: The COVID-19 pandemic has placed immense pressure on healthcare workers (HCWs). Objectives: This study sought to find the prevalence and factors associated with psychological distress among HCWs in South Africa during the beginning phases of COVID-19 and make relevant recommendations. Method: The survey was administered online through a data-free platform. Data were benchmarked to the national population of over 500 000 healthcare professionals in South Africa. Multiple logistic regressions were used to determine association between psychological distress and potential explanatory variables. Results: A total of 7607 healthcare professionals participated in the study (1760 nurses, 2843 medical practitioners and 3004 other healthcare professionals). Half of the nurses, 41% of medical practitioners and 47% of other healthcare professionals were classified as psychologically distressed. Those who were of older age, provided with well-being support services and having a positive outlook on the healthcare system were significantly less likely to be distressed. Being female medical practitioners and female other healthcare professions, requesting routine counselling, being concerned about not having enough leave and that their life insurance policy did not cover COVID-19 were more likely to be distressed. Conclusion: Psychological well-being of HCWs in South Africa is at risk. We recommend that psychological distress of HCWs be routinely assessed and that routine counselling, well-being support services, appropriate hazardous leave and insurance be provided to all HCWs. Contribution: This study adds to the literature on the psychological distress faced by HCWs in South Africa during COVID-19.

The function of competitive intelligence in South African insurance post-COVID-19 outbreak

Background: Competitive intelligence (CI) involves monitoring competitors and providing organizations with actionable and meaningful intelligence. Some studies have focused on the role of CI in other industries post-COVID-19 pandemic. Objectives: This article aims to examine the impact of COVID-19 on the South African insurance sector and how the integration of CI and related technologies can sustain the South African insurance sector post-COVID-19 epidemic. Method: Qualitative research with an exploratory-driven approach was used to examine the impact of the COVID-19 pandemic on the South African insurance sector. Qualitative secondary data analyses were conducted to measure insurance claims and death benefits paid during the COVID-19 pandemic. Results: The research findings showed that the COVID-19 pandemic significantly impacted the South African insurance industry, leading to a reassessment of pricing, products, and risk management. COVID-19 caused disparities in death benefits and claims between provinces; not everyone was insured. Despite challenges, South African insurers remained well-capitalised and attentive to policyholders. Integrating CI and analytical technologies could enhance the flexibility of prevention, risk management, and product design. Conclusion: COVID-19 requires digital transformation and CI for South African insurers' competitiveness. Integrating artificial intelligence (AI), big data (BD), and CI enhances value, efficiency, and risk assessments. Contribution: This study highlights the importance of integrating CI strategies and related technologies into South African insurance firms' operations to aid in their recovery from the COVID-19 crisis. It addresses a research gap and adds to academic knowledge in this area.

Prevalence and determinants of burnout among South African doctors during the COVID-19 pandemic

Background: Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout. Aim: This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic. Setting: Three public sector hospitals in Gqeberha, South Africa. Methods: A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout. Results: The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71­26.40), being in the lowest income band (AOR = 10.78, 2.55­45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12­8.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92­13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98­10.18). Low support at work (AOR = 9.99, 3.66­27.23), medium job satisfaction (AOR = 5.38, 2.65­10.93) and medium support at work (AOR = 3.39, 1.71­6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10­0.80) and high levels of resilience (AOR = 0.08, 0.03­0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout. Conclusion: The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors. Contribution: Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.

Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data

Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. Setting: The Public health sector, Gauteng province formed the setting for the study. Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. Contribution: This study provides insight into service provision for MNS disorders.

The adoption of ICT and robotic automation systems in the pharmaceutical industry

Background: South African pharmacies face challenges like cost reduction, inventory management, and employee efficiency. Balancing dispensing error rates and customer satisfaction, along with ensuring accurate medication dispensing, is also crucial. An effective solution to these challenges is adopting automatic robotic dispensing systems, which enhance stock inventory management, integrated systems, and accurate dispensing capabilities. Objectives: The study delved into IT and robotic automation in South African pharmaceutical dispensing, assessing current methods and advocating for integrated IT and Automated Storage and Retrieval Systems in retail and hospital pharmacies. Method: The research used a quantitative approach to gather data from public and private hospital pharmacy employees, aiming to understand their requirements and expectations. It assessed the potential improvements that could result from adopting a new system. Results: The study found that most government and private pharmacies in South Africa prefer automated dispensing systems to reduce errors, lower costs, improve customer service, and enhance inventory management. Benefits also included minimising medication errors, improving operational efficiency, and ensuring patient safety. Conclusion: The study holds importance as it underscores the necessity of integrating Information Technology (IT) and Robotic Automation in the pharmaceutical sector to address prevailing issues. It identifies factors contributing to medication dispensing errors and demonstrates the potential of automated robotic systems in mitigating these errors. Contribution: South Africa's pharmaceutical sector must enhance efficiency and competitiveness by adopting integrated IT and Robotic Automation Systems. The study identified key factors for future implementation and emphasized the need for clear pre-implementation policies outlining functions and benefits.

Alcohol consumption and associated factors among customers in Local Beer bars in South Africa: a Cross-Sectional Study

Background:Present study total participants were 700 males and females included with different age group and different education level. Topics of discussion included typical drinking reasons- Daily Habitual, stress, emotions type/mood (happy/Sad), burden, and party and the drink type like only beer, only whisky/vodka/wine and both. Methods:The legal age of wine purchase in South Africa is 18 years and on. We have analysed the age groups 18-25, 26-45, and 45-65, with the interviews having the general questions regarding the reason of drinking. Preliminary bar visits were carried out in ten bars and restaurants to develop and identify any potential problems with the planned data collection protocols and to determine which specific reason were common in bar customers will emphasized during the main study. Bar and restaurant visits in the main study began in June 2021 and were completed in March 2022, bar visits were made from 3 p.m. to 10 p.m. on nights randomly. Results: The customers we studies having majority of males than female observed. In daily habitual is high in age of 26-45 41.57%, in stress high rate is in unemployed of 57.71%, in workload burden alcohol consumption is age group 26-45 of 51.71%, in Party criteria age group 57.85%, In Emotions type/mood (happy/Sad) alcohol consumption is in category unemployed of 83%. Conclusion: Support the need for additional research to develop effective prevention and intervention strategies to reduce high-risk alcohol

Clinical outcome and incidence of inhibitor development in severe hemophilia patients receiving low-dose prophylaxis: a 3-year follow-up study in Senegal, West Africa

ABSTRACT Introduction: In Africa, where access to diagnosis and treatment of hemophilia is the lowest in the world, prophylaxis is rarely used in preference to on-demand treatment. There are limited data of prophylaxis treatment from sub-Saharan Africa. The aim of this study was to evaluate clinical outcomes and inhibitor development in people with hemophilia receiving low-dose prophylaxis (LDP) in a sub-Saharan African setting. Methods: We conducted a three-year prospective study. A once or twice weekly prophylaxis regimen of 25 IU/kg of rFVIIIFc or 30 IU/kg of rFIXFc was given to Hemophilia A and B, respectively. We evaluated clinical outcomes and inhibitors occurrence, determined by screening and titration using the Nijmegen technique. Results: A total of 15 patients were included in the LDP regimen. The mean age was 6.3 years (1.5 - 10). A significant reduction was noted in the annualized bleeding rate, from 7.53 to 1.33 (p = 0.0001); the annualized joint bleeding rate passed from 3.6 to 1.4 (p = 0.001) and the proportion of severe bleeding, from 86.1% to 16.7% (p = 0.0001). The Hemophilia Joint Health Score (HJHS) moved from 9.6 to 3.4 (p = 0.0001) and the Functional Independence Score in Hemophilia (FISH) improved from 25.8 to 30.9 (p = 0.0001). School absenteeism decreased from 7.33% to 2.59%. Adherence to prophylaxis was 89.5% versus 60%. Consumption was 580 IU/kg/year versus 1254.6 IU/kg/year before and after prophylaxis, respectively. Incidence of inhibitors was 23% (3 /13 HA). Conclusion: The LDP in Hemophilia improves the clinical outcome without a surplus risk of inhibitor development. Using extended half-life clotting factor concentrates (CFCs) is better for prophylaxis in resource-limited countries, as they allow better compliance in treatment.

Factors associated with delayed diagnosis among sub-Saharan African women

Breast cancer incidence in sub-Saharan Africa is among the lowest in the world; however, mortality is as high as in high-incidence countries because of poor survival rates. Most breast cancer patients in sub-Saharan Africa are diagnosed at advanced stages after prolonged symptomatic periods. Understanding the reasons why women in sub-Saharan Africa seek care after the onset of symptoms is essential to promoting early diagnosis and ultimately improve their cancer survival.

Analysis of Otorhinolaryngology Practices-Challenges of Specialists and Facilties-in sub-Saharan Africa

Background: More than 95% of the population in sub-Saharan Africa (S.S.A.) does not have ready access to safe, affordable surgical care, and there is a desperate need for E.N.T. (ear, nose, and throat), audiology, and speech therapy services. Therefore, from an international outlook, the most significant challenge confronting hearing and cancer care delivery is not high-technology and high-cost medicine but the lack of access to even the most elementary E.N.T. care Materials and Methods: A literature search for studies on the analysis of trends and outcomes of otorhinolaryngology practices in sub-Saharan Africa was performed using Google Scholar search database, PubMed, Medline, and ScienceDirect. The bibliographies of included studies were also searched for additional references. About 95 articles were identified. Twenty-one articles were considered suitable for the review. The whole residents of the 22Results: countries illustrated in a study reviewed were 720,500,000; this symbolizes 75% of the population of sub-Saharan Africa. Among the 22 countries that were tested, 847 ENT surgeons, 580 audiologists, 906 speech therapists, 264 ENT clinical officers, and 320 oncologists were reported. When data have combined the sample, the regional ratio was 1.2 million people per E.N.T. surgeon, 0.8 million people per audiologist, and 1.3 million people per speech therapist. Conclusion: Basic E.N.T. and airway-related interventions are possible in most countries that responded; life-saving procedures such as tracheostomy (and tracheostomy tubes), bronchoscopy, and balloon dilatation were not readily available in all countries. Access to hearing screening was very poor in most countries, highlighting the undocumented burden of disease of hearing loss in Africa and other LMICs, estimated at 5% of the world's population

Etiology of Chronic Kidney Disease in Nigeria and Management Challenges

The prevalence of chronic kidney disease (CKD) is increasing globally and is one of the noncommunicable diseases associated with increase mortality globally in the last two decades. The prevalence of CKD in Nigeria, it is 1.6% to 12.4%. Ninety percent of end-stage renal disease (ESRD) patients are said to die within 3 months of commencing dialysis. Indices are even worse in resource poor countries like Nigeria where prevention and adequate intervention are usually hampered by funds. In regions like Nigeria, it will be cheaper to prevent CKD than treating its complications. Hence, it is important to identify the common etiologies of CKD in Nigeria and prevent or promptly address them before causing irreversible damage to the kidneys. The most common cause of CKD in Nigeria includes hypertension, glomerulonephritis and diabetes mellitus. Many of these etiologies are preventable/treatable and should be looked for as a major way to reduce the incidence of CKD in Nigeria. Challenges identified in Nigeria, propagating CKD include westernization, inadequate manpower, late presentation, diagnostic challenge and poorly equipped facilities. Interventions like encouraging healthy lifestyle, making available essential drugs, training of health personnel, subsidized cost of treatment, legislation and policies to curb drug abuse. Therefore, resource-poor settings should focus on creating more awareness and making legislations and/or policies focused on these preventable causes of CKD as this is more realistic and effective in these settings.

Topics, Concerns, and Feelings Commented on Facebook after the First Death by COVID-19 in Mozambique / Temas, preocupaciones y sentimientos comentados en Facebook tras la primera muerte por COVID-19 en Mozambique

In Mozambique, as in other parts of the world, COVID-19 has had consequences in many areas, especially in the health sector. This study aims to analyze the comments made and discussed on Facebook after the first death from the disease, verifying the main topics, concerns, and feelings that users most expressed on that social network. Using the content analysis method, IRaMuTeQ® generated a dendrogram focused on death, diagnostic circumstances, disease prevention, and restrictive government measures. Users also raised concerns about health care professionals, family and community, and feelings of sadness. Although the feelings presented reflect the lan-guage used in comments on a social network, and it is impossible to diagnose from them, this study creates paths for further research in the area. Therefore, for the first time, it demonstrates results from a mental health study with data analyzed from a social network in Mozambique. These results can guide and alert local health entities about health communications, strategies, and attention that should be given to the mental health of individuals during this pandemic and in the long term

En Mozambique, como en otras partes del mundo, el COVID-19 trajo consecuencias en muchas áreas, principalmente en el sector de la salud. Este estudio tiene como objetivo analizar los comentarios realizados y discutidos en Facebook después de la primera muerte por la enfermedad, con el fin de verificar los principales temas, preocupaciones y sentimientos que los usuarios más expresaron en esa red social. Utilizando el método de análisis de contenido, IRaMuTeQ® generó un dendrograma con temas enfocados en las circunstancias de la muerte, las circunstancias del diagnóstico, la prevención de enfermedades, y las medidas restrictivas del gobierno. También hubo preocupaciones con los profesionales de la salud, la familia y la comunidad, además de sentimientos de tristeza. Aunque los sentimientos presentados reflejan el lenguaje utilizado en los comentarios en una red social, y no es posible dar un diagnóstico basado en ellos, este estudio abre caminos para futuras investigaciones en el área. Por lo tanto, por primera vez, se demuestra un estudio de salud mental con datos analizados en una red social en Mozambique, y puede servir como ayuda y alerta a las entidades locales de salud sobre comunicaciones de salud, estrategias y atención que se debe dar a la salud mental de las personas durante esta pandemia y a largo plazo

Doenças de africanos, doença africana: transformações da quijila, entre a África centro-ocidental e as Minas Gerais, Brasil, séculos XVII e XVIII / Diseases of Africans, an African disease: transformations of quijila between Central West Africa and Minas Gerais, in Brazil, in the seventeenth and eighteenth centuries

Resumo Este artigo discute a origem da quijila/kijila na cultura centro-ocidental africana, mais particularmente no universo cultural dos imbangalas (jagas) e das populações ambundos e kimbundos, que viviam nas regiões portuguesas de Angola e do Congo, nos séculos XVII e XVIII. Em seguida, investiga como foi estruturado, compreendido e transformado o conceito de quijila tanto na África, basicamente um interdito alimentar, mas cujos significados e aplicações variam, quanto no Brasil, para onde foi transportado nos Setecentos, transformando-se numa doença que atacava os negros, especialmente os africanos de diversas origens, sendo enquadrada pelos médicos locais no universo da medicina hipocrática-galena vigente na época.

Abstract This article discusses the origin of quijila/kijila in Central West African culture, more particularly in the cultural universe of the Imbangala (Jaga) and the Ambundu and Kimbundu populations who lived in the Portuguese regions of Angola and the Congo in the seventeenth and eighteenth centuries. Following this, it investigates how the concept of quijila was structured, comprehended, and transformed, both in Africa, where it was basically a food prohibition, but whose applications and meanings varied; and in Brazil, to where it was transported in the 1700s, and where it transformed into a disease which attacked blacks, especially Africans of various origins, being framed as such in the Hippocratic-Galen universe characteristic of that time.

Seroprevalence of viral transfusion transmissible infections (HBsAg, anti-HCV, anti-HIV, Syphilis) and coinfection among healthy volunteer blood donors during 5-years in Luanda, Angola

Abstract Background The transmission of diseases by blood products continues to be a worldwide health problem, especially in Africa. Seroprevalence rates of the Hepatitis B virus (HBV), Hepatitis C virus (HCV), Human Immunodeficiency Virus (HIV), Syphilis, and Coinfection in Angola are poorly documented. This study aims to identify the seroprevalence of markers with positive results for Hepatitis B, C, HIV, Syphilis, and Coinfection in blood donors. Material and methods A retrospective study was conducted using a database of positive serological markers for these infections and coinfection in 2734 blood donors traced from 2011 to 2016 in Luanda, Angola. The Chi-Square test (χ2) or Fisher's exact test was used to evaluate serological positivity and donors' characteristics. A p-value < 0.05 was considered statistically significant. Results 2734 blood donors aged 18 to 64 (median age 32 ± 9) were screened from 2011 to 2016. 73.9 % of the donors were positive for one Transfusion-Transmitted Infection (TTI), and 5.9 % showed evidence of multiple infections. The overall seroprevalence rate was 50.2 % (1373) for HBV, 20 % (436) for Syphilis, 7 % (191) for HIV, 5.1 % (140) for HCV, and 5.8 % for coinfected donors. 2467 (90 %) were men, and 267 (10 %) were women. We identified 118 (5.8 %) coinfected donors. Of those, 40 (33.9 %) simultaneously presented Hepatitis B virus surface antigen (HBsAg)/Syphilis, 24 (20.3 %) HBsAg/HIV, 22 (18.6 %) HBsAg/HCV, 20 (16.9 %) HIV/Syphilis, 8 (6.8 %) HCV/Syphilis, and 4 (3.4 %) HIV/HCV. Conclusion A high transfusion-transmissible infection prevalence was found compared to some countries in Sub-Saharan Africa. Therefore, intensifying the screening for these transfusion-transmitted infections in blood donors is critical to ensure blood safety.

The COVID-19 pandemic in sub-Saharan Africa: The significance of presumed immune sufficiency

A novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in China in 2019 and later ignited a global pandemic. Contrary to expectations, the effect of the pandemic was not as devastating to Africa and its young population compared to the rest of the world. To provide insight into the possible reasons for the presumed immune sufficiency to coronavirus disease 2019 (COVID-19) in Africa, this review critically examines literature published from 2020 onwards on the dynamics of COVID-19 infection and immunity and how other prevalent infectious diseases in Africa might have influenced the outcome of COVID-19. Studies characterising the immune response in patients with COVID-19 show that the correlates of protection in infected individuals are T-cell responses against the SARSCoV-2 spike protein and neutralising titres of immunoglobin G and immunoglobin A antibodies. In some other studies, substantial pre-existing T-cell reactivity to SARS-CoV-2 was detected in many people from diverse geographical locations without a history of exposure. Certain studies also suggest that innate immune memory, which offers protection against reinfection with the same or another pathogen, might influence the severity of COVID-19. In addition, an initial analysis of epidemiological data showed that COVID-19 cases were not severe in some countries that implemented universal Bacillus Calmette­Guerin (BCG) vaccination policies, thus supporting the potential of BCG vaccination to boost innate immunity. The high burden of infectious diseases and the extensive vaccination campaigns previously conducted in Africa could have induced specific and non-specific protective immunity to infectious pathogens in Africans.

How did South Africans with disabilities experience COVID-19? Results of an online survey

Background: People with disabilities are a large, disadvantaged minority, comprising approximately 12% of the population. The South African government has ratified international and regional disability treaties but deals with disability rights within general anti-discrimination legislation. There are no specific frameworks to monitor justice for people with disabilities. The study aims to inform further development of disability inclusive mechanisms relating to crises including pandemics. Objectives: This study explored the perceptions of South Africans with disabilities, to understand their experiences during coronavirus disease 2019 (COVID-19), focussing on socioeconomic, well-being and human rights aspects. Method: An online survey tool generated quantitative and qualitative data. Widespread publicity and broad recruitment were achieved through project partners networks. Participants responded via mobile phone and/or online platforms. Results: Nearly 2000 people responded, representing different genders, impairments, races, socio-economic status, education and ages. Findings include: (1) negative economic and emotional impacts, (2) a lack of inclusive and accessible information, (3) reduced access to services, (4) uncertainty about government and non-government agencies' support and (5) exacerbation of pre-existing disadvantages. These findings echo international predictions of COVID-19 disproportionally impacting people with disabilities. Conclusion: The evidence reveals that people with disabilities in South Africa experienced many negative impacts of the pandemic. Strategies to control the virus largely ignored attending to human rights and socioeconomic well-being of this marginalised group. Contribution: The evidence will inform the development of the national monitoring framework, recognised by the South African Government and emphasised by the United Nations as necessary to ensure the realisation of the rights of people with disabilities during future crises including pandemics.

COVID-19 impact on newly initiated and restarted antiretroviral treatment patients in the Eastern Cape, South Africa

Background: Initiating newly diagnosed people living with human immunodeficiency virus (HIV) onto antiretroviral treatment (ART) and retaining patients on treatment are vital to South Africa's ART programme. In 2020, coronavirus disease 2019 (COVID-19) and its accompanying containment (lockdown) measures presented unprecedented challenges to achieving these objectives. Aim: This study describes the impact of COVID-19 and related restrictions on district-level numbers of newly diagnosed people living with HIV and defaulting ART patients. Setting: Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape of South Africa. Methods: Mixed-methods approach: Monthly aggregated electronic patient data (newly initiated and restarted on ART) from 113 public healthcare (PHC) facilities were analysed (December 2019 to November 2020) across varying levels of COVID-19 lockdown regulation periods; telephonic in-depth interviews at 10 rural BCMM PHC facilities were conducted with facility staff, community health workers (CHWs) and intervention personnel. Results: The number of newly initiated ART patients decreased dramatically compared with pre-COVID-19 levels. The overall number of restarted ART patients increased in response to fears of co-infection with COVID-19. Facility-level communications and community outreach promoting HIV testing and treatment were disrupted. Novel approaches to providing services to ART patients were developed. Conclusion: Programmes for identifying undiagnosed people living with HIV and services aimed at retaining ART patients in care were profoundly impacted by COVID-19. The value of CHWs was highlighted, as were communication innovations. Contribution: This study describes the impact of COVID-19 and related regulations on HIV testing, ART initiation and adherence to treatment in a District of the Eastern Cape of South Africa.

The mental health and wellbeing of healthcare workers during COVID-19 in South Africa

Background: Little is known about the experiences and impact of coronavirus disease 2019 (COVID-19) on the mental health and wellbeing of healthcare workers (HCWs), particularly in Global South contexts. Aim: The authors aimed to explore the experiences of HCWs at different points during the COVID-19 pandemic in South Africa. Setting: This study's sample included 621 HCWs from various professions and health sectors who completed the survey during the pandemic peaks of waves I, II and III in South Africa. Methods: The authors used a qualitative survey design exploring participants' general work, life, mental health and wellbeing experiences, and their support mechanisms or strategies. Data were analysed using thematic analysis. Results: The authors identified three overarching themes in the data, namely stress, adjustment to work during COVID-19, and support experiences and needs. These themes were common across all three survey waves, with some minor differences noted across the waves. Conclusion: An overarching thread of uncertainty seems central to HCWs' experiences of working during COVID-19, related to pressures in the South African healthcare system that have been aggravated by the pandemic. Contribution: These findings have the potential to inform the development of contextually relevant approaches to support the mental health and wellbeing needs of HCWs during and after a pandemic. In particular, workplaces need to actively offer psychological support to all HCWs, not just to workers traditionally defined as frontline.

Profil lipidique associé à l'obésité chez les adolescents à Brazzaville, Congo / Lipid profile among obese adolescents in Brazzaville, Congo

Contexte & objectif. Les modifications lipidiques chez les enfants obèses en Afrique noire sont peu documentées. Les objectifs de la présente étude étaient de déterminer chez les adolescents obèses le profil lipidique, et analyser les associations entre quelques paramètres anthropométriques et lipidiques. Méthodes. L'étude transversale a été réalisée à Brazzaville auprès de 82 adolescents âgés de 11 à 18 ans, répartis en 45 sujets obèses, 17 en état de surpoids et 20 poids normal. Des mesures de la taille, du poids, du tour de taille, des plis cutanés sous-scapulaire et tricipital ont été effectuées. Des prélèvements sanguins ont permis de déterminer les concentrations en cholestérol total, cholestérol-LDL, cholestérol-HDL et triglycérides. Résultats. Les concentrations lipidiques notées chez les adolescents obèses étaient significativement supérieures à celles des sujets de poids normal : cholestérol total, 1,70 vs 1,59g/L ; cholestérol-LDL, 1,03 vs 0,88g/L ; triglycérides, 1,18 vs 0,86. Par contre, celles du cholestérol-HDL étaient significativement inférieures : 0,42 vs 0,51g/L. Une corrélation positive a été retrouvée entre le rapport tour de taille/taille et le cholestérol-HDL (r=0,75 ; p=0,031). Conclusion. Nos résultats soulignent la nécessité de renforcer la prise en charge des enfants obèses afin de prévenir les facteurs de risque potentiels des maladies cardiovasculaires à l'âge adulte