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Perez-Urbano I, Dilraj A, Pitsi A, Hlongwane N, Abdelatif N, Dietrich J, Ahmed K. Strategies to Close the PrEP Uptake Gap Among Transgender People and Men Who Have Sex with Men in Tshwane, South Africa: Perspectives from the Community. AIDS Behav 2024:10.1007/s10461-024-04300-7. [PMID: 38427124 DOI: 10.1007/s10461-024-04300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
HIV Pre-exposure Prophylaxis (PrEP) uptake among transgender (TG) people and gay men and other men who have sex with men (MSM) remains low, despite South Africa being the first African country to approve PrEP. This mixed-methods study used a two-phase explanatory sequential design: (1) quantitative analysis of cross-sectional surveys followed by (2) qualitative in-depth interviews. This study explored facilitators and barriers to PrEP uptake to identify strategies to increase utilization in these key populations. We conducted 202 cross-sectional surveys and 20 in-depth interviews between July 2021 and March 2022 in Soshanguve, Tshwane, Gauteng. Quantitative data were analyzed using univariate logistic regression; thematic analysis was performed for qualitative data. Findings show high willingness to use PrEP but low PrEP uptake. We outline strategies to facilitate PrEP use: (1) demystify daily PrEP by deploying community-engaged PrEP education campaigns; (2) capitalize on existing peer networks; and (3) expand accessible and culturally responsive PrEP service delivery models. We provide feasible recommendations to close the PrEP uptake gap in these key populations in South Africa.
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Affiliation(s)
- India Perez-Urbano
- University of California San Francisco School of Medicine, San Francisco, CA, 94143, USA.
| | | | - Annah Pitsi
- Setshaba Research Centre, Tshwane, Soshanguve, South Africa
| | | | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- African Social Sciences Unit of Research and Evaluation (ASSURE), Wits Health Consortium, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa
| | - Khatija Ahmed
- Setshaba Research Centre, Tshwane, Soshanguve, South Africa
- Department of Medical Microbiology, University of Pretoria, Tshwane, South Africa
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Kapwata T, Abdelatif N, Scovronick N, Gebreslasie MT, Acquaotta F, Wright CY. Identifying heat thresholds for South Africa towards the development of a heat-health warning system. Int J Biometeorol 2024; 68:381-392. [PMID: 38157021 PMCID: PMC10794383 DOI: 10.1007/s00484-023-02596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
Exposure to heatwaves may result in adverse human health impacts. Heat alerts in South Africa are currently based on defined temperature-fixed threshold values for large towns and cities. However, heat-health warning systems (HHWS) should incorporate metrics that have been shown to be effective predictors of negative heat-related health outcomes. This study contributes to the development of a HHWS for South Africa that can potentially minimize heat-related mortality. Distributed lag nonlinear models (DLNM) were used to assess the association between maximum and minimum temperature and diurnal temperature range (DTR) and population-adjusted mortality during summer months, and the effects were presented as incidence rate ratios (IRR). District-level thresholds for the best predictor from these three metrics were estimated with threshold regression. The mortality dataset contained records of daily registered deaths (n = 8,476,532) from 1997 to 2013 and data for the temperature indices were for the same period. Maximum temperature appeared to be the most statistically significant predictor of all-cause mortality with strong associations observed in 40 out of 52 districts. Maximum temperature was associated with increased risk of mortality in all but three of the districts. Our results also found that heat-related mortality was influenced by regional climate because the spatial distribution of the thresholds varied according to the climate zones across the country. On average, districts located in the hot, arid interior provinces of the Northern Cape and North West experienced some of the highest thresholds compared to districts located in temperate interior or coastal provinces. As the effects of climate change become more significant, population exposure to heat is increasing. Therefore, evidence-based HHWS are required to reduce heat-related mortality and morbidity. The exceedance of the maximum temperature thresholds provided in this study could be used to issue heat alerts as part of effective heat health action plans.
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Affiliation(s)
- Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, 2028, South Africa.
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, 0028, South Africa.
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Durban, 4001, South Africa
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Michael T Gebreslasie
- School of Agriculture, Earth, and Environmental Sciences, University of KwaZulu-Natal, Durban, 3629, South Africa
| | | | - Caradee Y Wright
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, 0028, South Africa
- Environment and Health Research Unit, South African Medical Research Council, Pretoria, 0084, South Africa
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Abdelatif N, Naidoo I, Dunn S, Mazinu M, Essack Z, Groenewald C, Maharaj P, Msomi N, Reddy T, Roberts B, Zuma K. Heterogeneity in COVID-19 infection among older persons in South Africa: Evidence from national surveillance data. Front Public Health 2023; 11:1009309. [PMID: 37006523 PMCID: PMC10061133 DOI: 10.3389/fpubh.2023.1009309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundThe 2021 World Health Organization study on the impact of COVID-19 on older people (≥60 years) in the African region highlighted the difficulties they faced as the virus spread across borders and dominated the way of life. These difficulties included disruptions to both essential health care services and social support, as well as disconnections from family and friends. Among those who contracted COVID-19, the risks of severe illness, complications, and mortality were highest among near-old and older persons.ObjectiveRecognizing that older persons are a diverse group including younger- and older-aged individuals, a study was conducted to track the epidemic among near-old (50–59 years) and older persons (≥60 years) in South Africa covering the 2 years since the epidemic emerged.MethodsUsing a quantitative secondary research approach, data for near-old and older persons were extracted for comparative purposes. COVID-19 surveillance outcomes (confirmed cases, hospitalizations, and deaths) and vaccination data were compiled up to March 5th, 2022. COVID-19 surveillance outcomes were plotted by epidemiological week and epidemic waves to visualize the overall growth and trajectory of the epidemic. Means for each age-group and by COVID-19 waves, together with age-specific rates, were calculated.ResultsAverage numbers of new COVID-19 confirmed cases and hospitalizations were highest among people aged 50–59- and 60–69-years. However, average age-specific infection rates showed that people aged 50–59 years and ≥80 years were most vulnerable to contracting COVID-19. Age-specific hospitalization and death rates increased, with people aged ≥ 70 years most affected. The number of people vaccinated was slightly higher among people aged 50–59 years before Wave Three and during Wave Four, but higher among people aged ≥ 60 years during Wave Three. The findings suggest that uptake of vaccinations stagnated prior to and during Wave Four for both age groups.DiscussionHealth promotion messages and COVID-19 epidemiological surveillance and monitoring are still needed, particularly for older persons living in congregate residential and care facilities. Prompt health-seeking should be encouraged, including testing and diagnosis as well as taking up vaccines and boosters, particularly for high-risk older persons.
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Affiliation(s)
- Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Inbarani Naidoo
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- *Correspondence: Inbarani Naidoo
| | - Shanaaz Dunn
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Mikateko Mazinu
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zaynab Essack
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Pietermaritzburg, South Africa
- Honorary Research Fellow, School of Law, and Honorary Research Associate, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Candice Groenewald
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- Honorary Research Associate, Rhodes University, Grahamstown, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Nokukhanya Msomi
- Discipline of Virology, University of KwaZulu-Natal and National Health Laboratory Services, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Benjamin Roberts
- Developmental, Capable and Ethical State Division, Human Sciences Research Council, Durban, South Africa
| | - Khangelani Zuma
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
- Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Rapiti N, Abdelatif N, Moosa MYS. Prognostic variables and 4-year survival outcomes in CD20 Positive AIDS-Related Lymphoma in the Anti-retroviral treatment era: A Retrospective Review from a Single Centre in KwaZulu-Natal, South Africa. PLoS One 2022; 17:e0272282. [PMID: 36048870 PMCID: PMC9436083 DOI: 10.1371/journal.pone.0272282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/16/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To describe 4-year survival outcomes and assess the value of established and additional relevant variables to predict complete response (CR), four-year progression-free survival (PFS) and overall survival (OS) of CD20 positive AIDS-Related Lymphoma (ARL) treated with standard combination chemotherapy. Method We performed a retrospective review of patients diagnosed with CD20 positive ARL between 2006 and 2016. All patients over 12 years of age who received at least one cycle of combination chemotherapy with curative intent were included in the analysis. Variables assessed included the International Prognostic Index (IPI), age-adjusted-IPI, age, gender, B symptoms, extent of disease, functional performance status, CD4 cell count, viral load, concurrent ART with chemotherapy, rituximab inclusion, and number of chemotherapy cycles used. Kaplan-Meier survival curves for OS and PFS at 4 years were compared for IPI and aaIPI using the log-rank test. A Cox proportional hazards model was used to investigate the effects of prognostic variables for patients achieving OS and PFS at 4 years and logistic regression for patients achieving CR. Results A total of 102 patients were included in the analysis. At year four of follow-up, the OS was 50% (n = 51) and PFS was 43% (n = 44). Attaining a CR and male gender were significantly associated with improved 4-year OS (p<0.001 and p = 0.028 respectively) and PFS (p<0.001 and 0.048 respectively). A viral load of < 50 copies/ml was associated with a higher complete response rate (aOR 6.10 [95% CI 1.15, 24.04], p = 0.01). Six or more cycles of chemotherapy was superior to fewer cycles for both PFS (aHR 0.17 [95% CI 0.10, 0.29]) and OS (aHR 0.12 [95% CI 0.07, 0.22]) with p-value < 0.001 for both PFS and OS. The Kaplan-Meier survival estimates demonstrated the prognostic utility of the IPI and aaIP for OS (p = 0.002 and 0.030 respectively) and the IPI for PFS (p = 0.002). Conclusion This study is a first from a high prevalence HIV area in KwaZulu-Natal, South Africa, and confirms the utility of the internationally accepted prognostic scoring systems in predicting survival in CD20 positive ARL in the local population.
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Affiliation(s)
- Nadine Rapiti
- Department of Haematology, NHLS/University of KwaZulu Natal/King Edward VIII Hospital, Durban, South Africa
- * E-mail:
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
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Chetty T, Singh Y, Odendaal W, Mianda S, Abdelatif N, Manda S, Schneider H, Goga A. Intervention in mothers and newborns to reduce maternal and perinatal mortality in three provinces in South Africa using a quality improvement approach: Protocol for a Mixed Method Type 2 Hybrid Evaluation (Preprint). JMIR Res Protoc 2022. [DOI: 10.2196/42041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Rapiti N, Abdelatif N, Rapiti A, Moosa MY. Patient characteristics and outcome of CD20-positive HIV-associated lymphoma: a single-center KwaZulu-Natal, South African hospital 12-year retrospective review. J Egypt Natl Canc Inst 2022; 34:32. [PMID: 35909189 DOI: 10.1186/s43046-022-00131-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/14/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Due to the high prevalence of HIV, HIV-associated lymphoma (HAL) is a common malignancy in South Africa. However, there is a paucity of literature on HAL from this region. The objective of this study was to profile the clinical characteristics and outcome of CD20-positive HAL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), with or without rituximab (R), from a single center in KwaZulu -Natal, South Africa. METHODS Retrospective chart review of adult patients treated from 2006 to 2018 for HIV-associated CD20-positive lymphoma. The clinical characteristics, complete response (CR), and 2-year overall survival (OS) are described. RESULTS The analysis included 102 patients, 54% females, median age of 39 years, and median CD4 cell count of 196 cells/μL. Bone marrow involvement was noted in 5%. Eighty-six percent of the cohort received concomitant antiretroviral therapy and chemotherapy, 76% of the CHOP group, and 92% of the R-CHOP group. Overall, a CR was seen in 55% (95% CI 45%; 65%), with a 2-year OS of 59% (95% CI 50%, 69%). A CR was attained in 46% on CHOP and 64% on R-CHOP, with a 2-year disease-free survival (DFS) for CHOP of 42% and 50% for R-CHOP. CONCLUSION Although the clinical characteristics and laboratory findings are similar to other higher-income cohorts, there was a difference in gender and incidence of marrow involvement. The low incidence of marrow involvement has prompted more routine use of immunohistochemistry and flow cytometry in staging marrows of HAL locally. Further randomized studies are required for the establishment of locally validated, cost-effective treatment guidelines.
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Affiliation(s)
- Nadine Rapiti
- Department of Haematology, NHLS/University of KwaZulu Natal/King Edward VIII Hospital, Durban, South Africa.
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Anand Rapiti
- Department of Neurosurgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Mahomed-Yunus Moosa
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
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Ramraj T, Abdelatif N, Chirinda W, Abdullah F, Kindra G, Goga A. A risk measurement tool for targeted HIV prevention measures amongst young pregnant and lactating women in South Africa. BMC Public Health 2022; 22:1277. [PMID: 35773638 PMCID: PMC9248185 DOI: 10.1186/s12889-022-13625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/09/2022] [Indexed: 11/11/2022] Open
Abstract
Background We aimed to develop and validate a tool to identify which pregnant/lactating young South African women (≤ 24 years) are at risk of HIV infection. Methods Data from three national South African Prevention of Mother-to-Child Transmission (PMTCT) evaluations were used to internally validate three HIV acquisition risk models for young postpartum women. We used univariate and multivariable logistic regression analysis to determine which risk factors were significant. Model coefficients were rounded and stratified into risk groups and the area under the receiver operating curve (AUROC) was computed. Models were developed to determine which risk factors provided the most predictive accuracy whilst remining clinically meaningful. Results Data from 9 456 adult and 4 658 young pregnant and lactating women were included in the development and validation data sets, respectively. The optimal model included the following risk factors: age (20–24 years old), informal house structure, two or more pregnancies, mothers who had knowledge of when they received their last HIV test result, no knowledge of the infant’s father’s HIV status, no knowledge of breastfeeding as a mode of MTCT and knowledge of PMTCT programme. The mean AUROC was 0.71 and 0.72 in the development and validation datasets respectively. The optimum cut off score was ≥ 27, having 84% sensitivity, 44% specificity, and identifying 44% of high-risk women eligible for PrEP. Conclusion The optimal model to be used as a possible risk scoring tool to allow for early identification of those pregnant/lactating women most at-risk of HIV acquisition included both statistically as well as clinically meaningful risk factors. A field-based study is needed to test and validate the effectiveness of this targeted approach.
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Affiliation(s)
- Trisha Ramraj
- Health Systems Research Unit, South African Medical Research Council, 491 Peter Mokaba Ridge, Durban, 4001, South Africa. .,HIV and other Infectious Diseases Research Unit, South African Medical Research Council, 491 Peter Mokaba Ridge, Durban, 4001, South Africa.
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, 491 Peter Mokaba Ridge, Durban, 4001, South Africa
| | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Council, 491 Peter Mokaba Ridge, Durban, 4001, South Africa
| | - Fareed Abdullah
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, 491 Peter Mokaba Ridge, Durban, 4001, South Africa.,Office of AIDS and TB Research, South African Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001, South Africa.,Division of Infectious Diseases, University of Pretoria, Pretoria, SA, South Africa
| | - Gurpreet Kindra
- US Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, Center for Global Health, Pretoria, SA, South Africa
| | - Ameena Goga
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, 491 Peter Mokaba Ridge, Durban, 4001, South Africa.,Department of Paediatrics and Child Health, University of Pretoria, Pretoria, SA, South Africa
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Rapiti N, Peer N, Abdelatif N, Rapiti P, Moosa Y. HIV-associated plasmablastic lymphoma: A single-centre 12-year experience in Kwa-Zulu Natal, South Africa. HIV Med 2022; 23:837-848. [PMID: 35229978 DOI: 10.1111/hiv.13266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/31/2021] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the clinical profile and outcome of patients with HIV-associated plasmablastic lymphoma (PBL) treated with cyclophosphamide, doxorubicin, oncovin, prednisone (CHOP) chemotherapy in a tertiary hospital in KwaZulu-Natal, South Africa. METHODS This 12-year retrospective clinical chart review, from 2006 to 2018, of patients with PBL treated with CHOP chemotherapy describes their clinical presentation, complete response (CR), progression-free survival (PFS) and disease-free survival (DFS). Response to salvage chemotherapy was also assessed, as was the overall survival (OS). RESULTS Of 26 patients included in the study, PBL was the presenting manifestation of underlying HIV infection in 58% (n = 15). The median age was 35 years (range 13-49), and 62% (n = 16) were males. The median CD4 count was 285 cells/µL (range 45-863). All patients had extranodal disease, with 4% having bone marrow involvement (n = 1) and > 60% presenting with advanced stage and high-risk PBL. Central nervous system (CNS) involvement was present in 15% (n = 4). A CR was attained in 46% (n = 12). The median DFS was 23.5 months (range 5-91 months), with an overall 2-year survival of 42% (n = 11). CONCLUSIONS Patients with PBL had a low CR with CHOP chemotherapy and poor OS. Use of alternative chemotherapy regimens needs to be investigated to optimally manage this aggressive lymphoma. The surprisingly low incidence of marrow involvement is the focus of ongoing local research.
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Affiliation(s)
- Nadine Rapiti
- Department of Haematology, NHLS/University of KwaZulu Natal/King Edward VIII Hospital, Durban, South Africa
| | - Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nada Abdelatif
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Pamela Rapiti
- Department of Paediatrics, University of KwaZulu Natal, Durban, South Africa
| | - Yunus Moosa
- Department of Infectious Diseases, University of KwaZulu Natal, Durban, South Africa
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Molepo L, Byrom B, Weyers B, Abdelatif N, Mahan S, Burridge M, Barbet A, Latif A. Development of inactivated heartwater (Ehrlichia ruminantium) vaccine in South Africa. Ticks Tick Borne Dis 2022; 13:101942. [DOI: 10.1016/j.ttbdis.2022.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
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Johnson R, Sharma JR, Ramharack P, Mangwana N, Kinnear C, Viraragavan A, Glanzmann B, Louw J, Abdelatif N, Reddy T, Surujlal-Naicker S, Nkambule S, Mahlangeni N, Webster C, Mdhluli M, Gray G, Mathee A, Preiser W, Muller C, Street R. Tracking the circulating SARS-CoV-2 variant of concern in South Africa using wastewater-based epidemiology. Sci Rep 2022; 12:1182. [PMID: 35064174 PMCID: PMC8783013 DOI: 10.1038/s41598-022-05110-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/31/2021] [Indexed: 12/13/2022] Open
Abstract
This study uses wastewater-based epidemiology (WBE) to rapidly and, through targeted surveillance, track the geographical distribution of SARS-CoV-2 variants of concern (Alpha, Beta and Delta) within 24 wastewater treatment plants (WWTPs) in the Western Cape of South Africa. Information obtained was used to identify the circulating variant of concern (VOC) within a population and retrospectively trace when the predominant variant was introduced. Genotyping analysis of SARS-CoV-2 showed that 50% of wastewater samples harbored signature mutations linked to the Beta variant before the third wave, with the Delta variant absent within the population. Over time, the prevalence of the beta variant decreased steadily. The onset of the third wave resulted in the Delta variant becoming the predominant variant, with a 100% prevalence supporting the theory that the Delta variant was driving the third wave. In silico molecular docking analysis showed that the signature mutations of the Delta variant increased binding to host proteins, suggesting a possible molecular mechanism that increased viral infectivity of the Delta variant.
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Affiliation(s)
- Rabia Johnson
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa.
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Centre for Cardiometabolic Research in Africa, Stellenbosch University, Stellenbosch, South Africa.
| | - Jyoti R Sharma
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
| | - Pritika Ramharack
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
- Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
| | - Noluxabiso Mangwana
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
| | - Craig Kinnear
- Genomics Centre, South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Amsha Viraragavan
- Genomics Centre, South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
| | - Brigitte Glanzmann
- Genomics Centre, South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Johan Louw
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Swastika Surujlal-Naicker
- Scientific Services, Water and Sanitation Department, City of Cape Town Metropolitan Municipality, Cape Town, South Africa
| | - Sizwe Nkambule
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Nomfundo Mahlangeni
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Candice Webster
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Johannesburg, South Africa
| | - Mongezi Mdhluli
- Office of the President, South African Medical Research Council, Tygerberg, 7050, South Africa
| | - Glenda Gray
- Office of the President, South African Medical Research Council, Tygerberg, 7050, South Africa
| | - Angela Mathee
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Johannesburg, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology at NHLS Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Christo Muller
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Tygerberg, 7505, South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Centre for Cardiometabolic Research in Africa, Stellenbosch University, Stellenbosch, South Africa
| | - Renee Street
- Environment and Health Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
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Potgieter A, Fabris-Rotelli IN, Kimmie Z, Dudeni-Tlhone N, Holloway JP, Janse van Rensburg C, Thiede RN, Debba P, Manjoo-Docrat R, Abdelatif N, Khuluse-Makhanya S. Modelling Representative Population Mobility for COVID-19 Spatial Transmission in South Africa. Front Big Data 2021; 4:718351. [PMID: 34746771 PMCID: PMC8570263 DOI: 10.3389/fdata.2021.718351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic starting in the first half of 2020 has changed the lives of everyone across the world. Reduced mobility was essential due to it being the largest impact possible against the spread of the little understood SARS-CoV-2 virus. To understand the spread, a comprehension of human mobility patterns is needed. The use of mobility data in modelling is thus essential to capture the intrinsic spread through the population. It is necessary to determine to what extent mobility data sources convey the same message of mobility within a region. This paper compares different mobility data sources by constructing spatial weight matrices at a variety of spatial resolutions and further compares the results through hierarchical clustering. We consider four methods for constructing spatial weight matrices representing mobility between spatial units, taking into account distance between spatial units as well as spatial covariates. This provides insight for the user into which data provides what type of information and in what situations a particular data source is most useful.
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Affiliation(s)
- A Potgieter
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - I N Fabris-Rotelli
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Z Kimmie
- Foundation of Human Rights, Johannesburg, South Africa
| | - N Dudeni-Tlhone
- Operational Intelligence, NextGen Enterprises and Institutions, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - J P Holloway
- Operational Intelligence, NextGen Enterprises and Institutions, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - C Janse van Rensburg
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - R N Thiede
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - P Debba
- Inclusive Smart Settlements and Regions, Smart Places, Council for Scientific and Industrial Research, Pretoria, South Africa.,Department of Statistics and Actuarial Science, University of Witwatersrand, Johannesburg, South Africa
| | - R Manjoo-Docrat
- Department of Statistics and Actuarial Science, University of Witwatersrand, Johannesburg, South Africa
| | - N Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - S Khuluse-Makhanya
- IBM Research, Johannesburg, South Africa.,College of Graduate Studies, University of South Africa, Johannesburg, South Africa
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12
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Pule V, Mathee A, Melariri P, Kapwata T, Abdelatif N, Balakrishna Y, Kunene Z, Mogotsi M, Wernecke B, Wright CY. Classroom Temperature and Learner Absenteeism in Public Primary Schools in the Eastern Cape, South Africa. Int J Environ Res Public Health 2021; 18:ijerph182010700. [PMID: 34682446 PMCID: PMC8535629 DOI: 10.3390/ijerph182010700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/02/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Abstract
Children spend a significant proportion of their time at school and in school buildings. A healthy learning environment that supports children should be thermally conducive for learning and working. Here, we aimed to study the relations between indoor classroom temperatures and learner absenteeism as a proxy for children’s health and well-being. This one-year prospective study that spanned two calendar years (from June 2017 to May 2018) entailed measurement of indoor classroom temperature and relative humidity, calculated as apparent temperature (Tapp) and collection of daily absenteeism records for each classroom in schools in and around King Williams Town, Eastern Cape province, South Africa. Classroom characteristics were collected using a standardized observation checklist. Mean indoor classroom temperature ranged from 11 to 30 °C, while mean outdoor temperature ranged from 6 °C to 31 °C during the sample period. Indoor classroom temperatures typically exceeded outdoor temperatures by 5 °C for 90% of the study period. While multiple factors may influence absenteeism, we found absenteeism was highest at low indoor classroom Tapp (i.e., below 15 °C). Absenteeism decreased as indoor Tapp increased to about 25 °C before showing another increase in absenteeism. Classroom characteristics differed among schools. Analyses of indoor classroom temperature and absenteeism in relation to classroom characteristics showed few statistically significant relations—although not exceptionally strong ones—likely because of the multiple factors that influence absenteeism. However, given the possible relationship between indoor temperature and absenteeism, there is a learning imperative to consider thermal comfort as a fundamental element of school planning and design. Furthermore, additional research on factors besides temperature that affect learner absenteeism is needed, especially in rural areas.
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Affiliation(s)
- Vicky Pule
- Department of Environmental Health, School of Behavioural and Lifestyle Sciences, Faculty of Health Sciences, Nelson Mandela University, Gqeberha 6019, South Africa; (V.P.); (A.M.); (P.M.)
| | - Angela Mathee
- Department of Environmental Health, School of Behavioural and Lifestyle Sciences, Faculty of Health Sciences, Nelson Mandela University, Gqeberha 6019, South Africa; (V.P.); (A.M.); (P.M.)
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa; (T.K.); (Z.K.); (M.M.); (B.W.)
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
| | - Paula Melariri
- Department of Environmental Health, School of Behavioural and Lifestyle Sciences, Faculty of Health Sciences, Nelson Mandela University, Gqeberha 6019, South Africa; (V.P.); (A.M.); (P.M.)
| | - Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa; (T.K.); (Z.K.); (M.M.); (B.W.)
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Durban 4001, South Africa; (N.A.); (Y.B.)
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban 4001, South Africa; (N.A.); (Y.B.)
| | - Zamantimande Kunene
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa; (T.K.); (Z.K.); (M.M.); (B.W.)
| | - Mirriam Mogotsi
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa; (T.K.); (Z.K.); (M.M.); (B.W.)
| | - Bianca Wernecke
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa; (T.K.); (Z.K.); (M.M.); (B.W.)
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
| | - Caradee Yael Wright
- Department of Environmental Health, School of Behavioural and Lifestyle Sciences, Faculty of Health Sciences, Nelson Mandela University, Gqeberha 6019, South Africa; (V.P.); (A.M.); (P.M.)
- Environment and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0002, South Africa
- Correspondence: ; Tel.: +27-12-339-8543
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13
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Abdelatif N, Peer N, Manda SO. National prevalence of coronary heart disease and stroke in South Africa from 1990-2017: a systematic review and meta-analysis. Cardiovasc J Afr 2021; 32:156-160. [PMID: 33769427 DOI: 10.5830/cvja-2020-045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/02/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND South Africa is experiencing an increasing burden of cardiovascular diseases, including coronary heart disease (CHD) and stroke. We aimed to obtain overall national prevalence estimates of CHD and stroke in South Africa. METHODS Studies conducted in South Africa were systematically reviewed from PubMed, Scopus and Web of Science from January 1990 to July 2017. Random-effects meta-analyses were conducted on the selected studies to determine the overall prevalence of CHD and stroke. RESULTS Out of 2 466 studies, only 12 covering 75 140 participants reported the national prevalence of CHD and stroke. All 12 studies estimated the national prevalence of both diseases based on self-reported disease status. The overall national prevalence was 1.29 (95% CI = 0.83; 1.75) and 4.29 (95% CI = 3.13; 5.45) for CHD and stroke, respectively. Only one study reported incidence rates so we did not perform any meta-analysis of incidence rates. CONCLUSIONS There are very few studies on national prevalence of CHD and stroke in South Africa. Well-structured registries for CHD and stroke are required to accurately identify the disease burden and enable adequate resources to be allocated for the implementation of appropriate prevention and management programmes.
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Affiliation(s)
- Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa.
| | - Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Samuel O Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria; Department of Statistics, University of Pretoria, Pretoria; School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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14
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Potgieter A, Fabris-Rotelli IN, Kimmie Z, Dudeni-Tlhone N, Holloway JP, Janse van Rensburg C, Thiede RN, Debba P, Manjoo-Docrat R, Abdelatif N, Khuluse-Makhanya S. Modelling Representative Population Mobility for COVID-19 Spatial Transmission in South Africa. Front Big Data 2021. [PMID: 34746771 DOI: 10.20944/preprints202106.0211.v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
The COVID-19 pandemic starting in the first half of 2020 has changed the lives of everyone across the world. Reduced mobility was essential due to it being the largest impact possible against the spread of the little understood SARS-CoV-2 virus. To understand the spread, a comprehension of human mobility patterns is needed. The use of mobility data in modelling is thus essential to capture the intrinsic spread through the population. It is necessary to determine to what extent mobility data sources convey the same message of mobility within a region. This paper compares different mobility data sources by constructing spatial weight matrices at a variety of spatial resolutions and further compares the results through hierarchical clustering. We consider four methods for constructing spatial weight matrices representing mobility between spatial units, taking into account distance between spatial units as well as spatial covariates. This provides insight for the user into which data provides what type of information and in what situations a particular data source is most useful.
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Affiliation(s)
- A Potgieter
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - I N Fabris-Rotelli
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Z Kimmie
- Foundation of Human Rights, Johannesburg, South Africa
| | - N Dudeni-Tlhone
- Operational Intelligence, NextGen Enterprises and Institutions, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - J P Holloway
- Operational Intelligence, NextGen Enterprises and Institutions, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - C Janse van Rensburg
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - R N Thiede
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - P Debba
- Inclusive Smart Settlements and Regions, Smart Places, Council for Scientific and Industrial Research, Pretoria, South Africa
- Department of Statistics and Actuarial Science, University of Witwatersrand, Johannesburg, South Africa
| | - R Manjoo-Docrat
- Department of Statistics and Actuarial Science, University of Witwatersrand, Johannesburg, South Africa
| | - N Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - S Khuluse-Makhanya
- IBM Research, Johannesburg, South Africa
- College of Graduate Studies, University of South Africa, Johannesburg, South Africa
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15
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Gibbs A, Abdelatif N, Said N, Jewkes R. Associations between exposures to occupation-related events, depression and intimate partner violence among women in the occupied Palestinian Territories. Glob Public Health 2020; 16:1834-1847. [PMID: 33222619 DOI: 10.1080/17441692.2020.1849349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
War and conflict impact on women's mental health and experiences of intimate partner violence (IPV), including in the occupied Palestinian Territories (oPT). Drawing on a cross-sectional population representative sample (n=534) collected in February 2017 in the oPT, we sought to (i) characterise the patterning of occupation-related events among women (18+) living in the oPT, (ii) to descriptively assess factors associated with this patterning, (iii) to assess the health impacts of occupation-related events by this patterning, specifically experience of IPV and poor mental health, and (iv) to assess the pathways through which occupation-related events are associated with IPV experience. Using Latent Class Analysis we identified three 'classes' of exposure to occupation-related events: 1 in 20 experienced multiple forms directed at themselves, their families and homes, 42.3% reported experiences against family members and their homes, and half reported relatively few direct experiences of occupation-related violence. Group membership was associated with increased past year IPV experience, and depressive symptoms. Using structural equation modelling we demonstrate that experiences of occupation-related events increased IPV experience via two mediated pathways; increased gender inequitable attitudes, and increased depressive symptoms and quarrelling with their husband. Preventing IPV requires addressing occupation-related events as well as transforming gender norms.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nader Said
- Arab World for Research and Development (AWRAD), Ramallah, Palestine
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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16
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Gibbs A, Abdelatif N, Washington L, Chirwa E, Willan S, Shai N, Sikweyiya Y, Jewkes R. Differential impact on men in an IPV prevention intervention: A post hoc analysis using latent class analysis of the Stepping Stones and Creating Futures intervention in South Africa. Soc Sci Med 2020; 265:113538. [PMID: 33257178 DOI: 10.1016/j.socscimed.2020.113538] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/09/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
Working with men to prevent their perpetration of intimate partner violence and non-partner sexual violence is increasingly recognised as effective. However, in any given context there are a multiplicity of masculinities, each of which has a different association with violence perpetration. There remains lack of clarity about whether such interventions impact all men and masculinities equally. We undertook a post-hoc analysis of men involved in the successful Stepping Stones and Creating Futures cluster randomized control trial in Durban, South Africa, to assess: i) whether there were different groups of men, ii) the factors associated with group allocation, and iii) whether the intervention had a differential impact on these groups in terms of violence perpetration. We used Latent Class Analysis (LCA) to identify masculinity classes, based on fit statistics and theoretical plausibility, and then used descriptive statistics (numbers, percentages, means) and p-values and multinomial models (95% confidence intervals, p-values) to assess factors associated with allocation to each class. To assess intervention impact by group, we used an intention-to-treat analysis, comparing men in each masculinity class, by intervention and control arm, using generalized estimating equations reporting unadjusted and adjusted odds ratios (aORs). In total 674 were recruited at baseline, and the LCA identified three classes of men: high violence (29% of men), medium violence (50% of men) and low violence (21% of men). Multinomial models showed those in more violent classes were more supportive of violence, had more adverse experiences, more depression and had worked more. By masculinity class, the impact of SS-CF showed reductions among the most violent men, with significant reductions in past year physical IPV (aOR0.59, p = 0.014), emotional IPV (aOR0.44, p = 0.044) and economic IPV (aOR0.35, p = 0.004), with non-significant reductions among other classes of men. This analysis suggests intensive group-based interventions can have significant impacts on the most violent men in communities.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Private Bag x385, 0001, Pretoria, South Africa; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building West Wing, Howard College Campus, Durban, South Africa.
| | - Nada Abdelatif
- Biostatistics Unit, South African Medical Research Council, PO Box 70380, 4091 Overport, Durban, South Africa.
| | - Laura Washington
- Project Empower, 20 Diakonia Ave, Durban Central, Durban, 4001, South Africa.
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Private Bag x385, 0001, Pretoria, South Africa; School of Public Health, University of Witwatersrand, 60 York Rd, Parktown, Johannesburg, 2193, South Africa.
| | - Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Private Bag x385, 0001, Pretoria, South Africa.
| | - Nwabisa Shai
- Gender and Health Research Unit, South African Medical Research Council, Private Bag x385, 0001, Pretoria, South Africa; School of Public Health, University of Witwatersrand, 60 York Rd, Parktown, Johannesburg, 2193, South Africa.
| | - Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, Private Bag x385, 0001, Pretoria, South Africa; School of Public Health, University of Witwatersrand, 60 York Rd, Parktown, Johannesburg, 2193, South Africa.
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Private Bag x385, 0001, Pretoria, South Africa; School of Public Health, University of Witwatersrand, 60 York Rd, Parktown, Johannesburg, 2193, South Africa; Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa Private Bag x385, 0001 Pretoria, South Africa.
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17
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Christofides NJ, Hatcher AM, Rebombo D, McBride RS, Munshi S, Pino A, Abdelatif N, Peacock D, Levin J, Jewkes RK. Correction to: Effectiveness of a multi-level intervention to reduce men's perpetration of intimate partner violence: a cluster randomised controlled trial. Trials 2020; 21:526. [PMID: 32546187 PMCID: PMC7296944 DOI: 10.1186/s13063-020-04386-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nicola J Christofides
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.
| | - Abigail M Hatcher
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.,Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, USA
| | - Dumisani Rebombo
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Ruari-Santiago McBride
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Shehnaz Munshi
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Angelica Pino
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Nada Abdelatif
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
| | - Dean Peacock
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Jonathan Levin
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Rachel K Jewkes
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.,South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
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18
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Christofides NJ, Hatcher AM, Rebombo D, McBride RS, Munshi S, Pino A, Abdelatif N, Peacock D, Levin J, Jewkes RK. Effectiveness of a multi-level intervention to reduce men's perpetration of intimate partner violence: a cluster randomised controlled trial. Trials 2020; 21:359. [PMID: 32334615 PMCID: PMC7183134 DOI: 10.1186/s13063-020-4185-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Abstract
Background Men’s perpetration of intimate partner violence (IPV) limits gains in health and wellbeing for populations globally. Largely informal, rapidly expanding peri-urban settlements, with limited basic services such as electricity, have high prevalence rates of IPV. Evidence on how to reduce men’s perpetration, change social norms and patriarchal attitudes within these settings is limited. Our cluster randomised controlled trial aimed to determine the effectiveness of the Sonke CHANGE intervention in reducing use of sexual and/or physical IPV and severity of perpetration by men aged 18–40 years over 2 years. Methodology The theory-based intervention delivered activities to bolster community action, including door-to-door discussions, workshops, drawing on the CHANGE curriculum, and deploying community action teams over 18 months. In 2016 and 2018, we collected data from a cohort of men, recruited from 18 clusters; nine were randomised to receive the intervention, while the nine control clusters received no intervention. A self-administered questionnaire, using audio-computer assisted software, asked about sociodemographics, gender attitudes, mental health, and the use and severity of IPV. We conducted an intention-to-treat analysis at the cluster level comparing the expected risk to observed risk of using IPV while controlling for baseline characteristics. A secondary analysis used latent classes (LCA) of men to see whether there were differential effects of the intervention for subgroups of men. Results Of 2406 men recruited, 1458 (63%) were followed to 2 years. Overall, we saw a reduction in men’s reports of physical, sexual and severe IPV from baseline to endpoint (40.2% to 25.4%, 31.8% to 15.8%, and 33.4% to 18.2%, respectively). Intention-to-treat analysis showed no measurable differences between intervention and control clusters for primary IPV outcomes. Difference in the cluster-level proportion of physical IPV perpetration was 0.002 (95% confidence interval [CI] − 0.07 to 0.08). Similarly, differences between arms for sexual IPV was 0.01 (95% CI − 0.04 to 0.06), while severe IPV followed a similar pattern (Diff = 0.01; 95% CI − 0.05 to 0.07). A secondary analysis using LCA suggests that among the men living in intervention communities, there was a greater reduction in IPV among less violent and more law abiding men than among more highly violent men, although the differences did not reach statistical significance. Conclusion The intervention, when implemented in a peri-urban settlement, had limited effect in reducing IPV perpetrated by male residents. Further analysis showed it was unable to transform entrenched gender attitudes and use of IPV by those men who use the most violence, but the intervention showed promise for men who use violence less. Trial registration ClinicalTrials.gov, NCT02823288. Registered on 30 June 2016.
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Affiliation(s)
- Nicola J Christofides
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.
| | - Abigail M Hatcher
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.,Division of HIV, Infectious Disease, and Global Medicine, University of California, SanFrancisco, USA
| | - Dumisani Rebombo
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Ruari-Santiago McBride
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Shehnaz Munshi
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Angelica Pino
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Nada Abdelatif
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
| | - Dean Peacock
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Jonathan Levin
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Rachel K Jewkes
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.,South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
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19
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Gibbs A, Washington L, Abdelatif N, Chirwa E, Willan S, Shai N, Sikweyiya Y, Mkhwanazi S, Ntini N, Jewkes R. Stepping Stones and Creating Futures Intervention to Prevent Intimate Partner Violence Among Young People: Cluster Randomized Controlled Trial. J Adolesc Health 2020; 66:323-335. [PMID: 31784410 DOI: 10.1016/j.jadohealth.2019.10.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Young people, not in formal employment or education, face exceedingly high levels of intimate partner violence (IPV). We evaluated whether Stepping Stones and Creating Futures, compared with a wait-list control, can reduce IPV and strengthen livelihoods. METHODS A cluster randomized controlled trial with 34 clusters in urban informal settlements in eThekwini Municipality, South Africa. Participant inclusion criteria were aged 18-30 years, resident in the informal settlement, and not working or in education. A total of 676 women and 646 men were recruited from September 2015 to September 2016. At recruitment, participants were not blinded to study arm. Endline data were collected from March to October 2018 (24 months postenrollment). Analyses were by intention-to-treat and separate for men and women. No clusters withdrew; endline retention was 74.9% (n = 505) men and 80.6% (n = 545) women. RESULTS At endline in the intervention arm, men's self-reported past year IPV perpetration was lower (physical IPV [adjusted odds ratio [aOR]: .71, 95% confidence interval [CI]: .51-.97], severe IPV [aOR: .70, 95% CI: .52-.94], and sexual IPV [aOR: .74, 95% CI: .54-1.03]). There was no difference in men's controlling behaviors (β = .06, 95% CI: -.51 to .63) or past month earnings (β = .21, 95% CI: -.42 to .83). For women, earnings were significantly higher in the intervention arm (β = .97, 95% CI: .43-1.51), but there were no differences for past year IPV experience (physical IPV [aOR: .92, 95% CI: .62-1.37]; sexual IPV [aOR: .90, 95% CI: .64-1.28], severe IPV [aOR: .93, 95% CI: .66-1.31]) or controlling behaviors (β = -.01, 95% CI: -.88 to .86). CONCLUSION Stepping Stones and Creating Futures is effective in reducing men's self-reported perpetration of IPV and strengthening women's livelihoods, but not women's experiences of IPV. TRIAL REGISTRATION NCT03022370. Registered January 13, 2017.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | | | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Nwabisa Shai
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Nolwazi Ntini
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Office of the Executive Scientist, South African Medical Research Council, Cape Town, South Africa
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Amel L, Leila BF, Lamia K, Olfa G, Abdelfattah Z, Mondher G, Faouzi M, Chakib K, Abdelatif N, Amor G, Slim BA. [Histologic and prognostic study of nephroblastoma in central Tunisia]. Ann Urol (Paris) 2003; 37:164-9. [PMID: 12951705 DOI: 10.1016/s0003-4401(03)00075-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nephroblastoma is a common malignant tumour in childhood that benefited from therapeutic progress. This is a retrospective study of 35 nephroblastoma diagnosed and treated in the central region of Tunisia within the last 8 years (1991-1999). We report and compare clinical features, therapeutic results and prognostic factors with those reported in the literature. The mean age was 3-years and 9 months, and the main clinical symptom was abdominal mass. Pre-operative chemotherapy was done in 32 cases and the objective response rate was 58%. Thirty-three patients had radical nephrectomy and only one had partial nephrectomy. Histologic analysis concluded to an anaplastic nephroblastoma in 2 cases. Using the classification of the international society of pediatric oncology, 11.4% of tumours were stage I, 48.6% stage II, 5.7% stage III, 11.4% stage IV and 2.9% stage V. The overall 5 years survival was 80%; tumour relapse was only independent prognosis factor in multivariate analysis (P < 0.01). Prognosis of nephroblastoma has been improved with chemotherapy and the pluridisciplinar treatment.
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Affiliation(s)
- L Amel
- Service de médecine carcinologique, CHU Farhat-Hached, Sousse 4000, Tunisie
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