Surveillance provides insight into epidemiology and spectrum of culture-confirmed mycobacterial disease in children.

BACKGROUND: Longer-term tuberculosis (TB) drug resistance surveillance among children is rare. We determined the prevalence of drug resistance among children with culture-confirmed TB from 2011 to 2013, compared these results with four previous consecutive 2-year periods and documented other mycobacterial isolates identified. METHOD: Surveillance study of mycobacterial culture in all children aged <13 years conducted from March 2011 to February 2013 at the Tygerberg Children's Hospital, Cape Town, South Africa. Drug susceptibility testing against isoniazid (INH) and rifampicin (RMP) was performed using line-probe assay (GenoType(®) MTBDRplus). Clinical data were obtained through folder review. RESULTS: Of 381 children, 323 (84.8%; 324 episodes) had Mycobacterium tuberculosis, 46 (12.1%) had M. bovis bacille Calmette-Guérin and 12 (3.1%) had non-tuberculous mycobacteria isolated. Forty-one (12.7%) children had M. tuberculosis resistant to INH and/or RMP; 15 (4.7%) had multidrug-resistant TB (MDR-TB). The prevalence of INH mono- or polyresistance remained stable; however, RMP monoresistance increased (0/313 in 2003-2005 vs. 6/324, 1.9%, in 2011-2013; P = 0.041); MDR-TB prevalence has declined significantly, from 26/292 (8.9%) in 2007-2009 to 15/324 (4.7%) in 2011-2013 (OR 0.50, 95%CI 0.24-0.99). The prevalence of human immunodeficiency virus co-infection has decreased significantly, from a peak of 29% to 15.3%. CONCLUSIONS: There has been a significant reduction in bacteriologically confirmed MDR-TB cases. The increase in RMP monoresistance has important implications for treatment.

Environmental factors and population at risk of malaria in Nkomazi municipality, South Africa.

OBJECTIVE: Nkomazi local municipality of South Africa is a high-risk malaria region with an incidence rate of about 500 cases per 100 000. We examined the influence of environmental factors on population (age group) at risk of malaria. METHODS: r software was used to statistically analyse data. Using remote sensing technology, a Landsat 8 image of 4th October 2015 was classified using object-based classification and a 5-m resolution. Spot height data were used to generate a digital elevation model of the area. RESULTS: A total of 60 718 malaria cases were notified across 48 health facilities in Nkomazi municipality between January 1997 and August 2015. Malaria incidence was highly associated with irrigated land (P = 0.001), water body (P = 0.011) and altitude ≤400 m (P = 0.001). The multivariate model showed that with 10% increase in the extent of irrigated areas, malaria risk increased by almost 39% in the entire study area and by almost 44% in the 2-km buffer zone of selected villages. Malaria incidence is more pronounced in the economically active population aged 15-64 and in males. Both incidence and case fatality rate drastically declined over the study period. CONCLUSION: A predictive model based on environmental factors would be useful in the effort towards malaria elimination by fostering appropriate targeting of control measures and allocating of resources.

Trends in childhood drug-resistant tuberculosis in South Africa: a window into the wider epidemic?

Childhood tuberculosis (TB) is a marker of TB transmission within a community. We present the fourth consecutive survey of children with culture-confirmed TB at a hospital in Cape Town, South Africa, from 2009 to 2011. In comparison to the previous survey, the rate of multidrug-resistant TB (MDR-TB) has stabilised and the human immunodeficiency virus infection rate has declined. We also report on the first systematic surveillance of resistance to second-line drugs. Two concerns following from this are the high rate (22%) of ofloxacin resistance in MDR-TB isolates, and the discordance between isolates with an inhA promoter region mutation, usually implying ethionamide (ETH) resistance, and phenotypic ETH results in these isolates showing ETH susceptibility.

Assessment of chemical and mineralogical characteristics of airborne dust in the Sistan region, Iran.

Windblown transport and deposition of dust is widely recognized as an important physical and chemical concern to climate, human health and ecosystems. Sistan is a region located in southeast Iran with extensive wind erosion, severe desertification and intense dust storms, which cause adverse effects in regional air quality and human health. To mitigate the impact of these phenomena, it is vital to ascertain the physical and chemical characteristics of airborne and soil dust. This paper examines for the first time, the mineralogical and chemical properties of dust over Sistan by collecting aerosol samples at two stations established close to a dry-bed lake dust source region, from August 2009 to August 2010. Furthermore, soil samples were collected from topsoil (0-5 cm depth) at several locations in the dry-bed Hamoun lakes and downwind areas. These data were analyzed to investigate the chemical and mineralogical characteristics of dust, relevance of inferred sources and contributions to air pollution. X-ray Diffraction (XRD) analysis of airborne and soil dust samples shows that the dust mineralogy is dominated mainly by quartz (30-40%), calcite (18-23%), muscovite (10-17%), plagioclase (9-12%), chlorite (~6%) and enstatite (~3%), with minor components of dolomite, microcline, halite and gypsum. X-ray Fluorescence (XRF) analyses of all the samples indicate that the most important oxide compositions of the airborne and soil dust are SiO(2), CaO, Al(2)O(3), Na(2)O, MgO and Fe(2)O(3), exhibiting similar percentages for both stations and soil samples. Estimates of Enrichment Factors (EFs) for all studied elements show that all of them have very low EF values, suggesting natural origin from local materials. The results suggest that a common dust source region can be inferred, which is the eroded sedimentary environment in the extensive Hamoun dry lakes lying to the north of Sistan.

Village health workers: first line of contact in the Republic of Ciskei.

PIP: This article defends the position that the development of a network of well-trained village health workers can provide an excellent first line of defense in primary health care and provides an example of the successful training of community health workers in the South Africa republic of Ciskei. In 1980, the 1st group of nurses received this training, which focused on child welfare, nutrition, antenatal and postnantal care, family planning motivation, environmental hygiene, tuberculosis control, and home visiting. After completion of the 3-month course, which emphasized practical rather than theoretical approaches, 10 candidates were stationed in 9 villages. Their initial functions included systematic home visiting to identify health problems, provide health education, and motivate people to make use of existing health services; attendance at weekly child welfare and antenatal clinics; follow up of cases involving malnutrition, home deliveries, psychiatric clients, tuberculosis contacts, and family planning clients; and meetings of a local Health Committee. Attendance at the mobile clinics in the villages where these nurses were stationed rose sharply. The 10 candidates who completed the 2nd training course were all attached to permanent clinics. However, it soon became evident that the enrolled nurses who completed the training often were not motivated for their work. Thus, changes were made to train nursing assistants rather than enrolled nurses, to increase training to 6 months, and to allow candidates to be selected by their own villages. Projects of these workers have included checking immunization status, weighing preschool children, and detecting common skin diseases. They call regular community meetings to discuss selected topics. The scheme is considered to have gained the support and cooperation of the community and headmen.^ieng