2. Academic Wits University Research Outputs (All submissions)

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ABBV744 as a potential inhibitor of SARSCoV2 main protease enzyme against COVID19
(Nature Research) Zeynab Fakhar; Shama Khan; Afrah Alkhuriji; Suliman Y. AlOmar; Aijaz Ahmad
A new pathogen severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) has spread worldwide and become pandemic with thousands new deaths and infected cases globally. To address coronavirus disease (COVID‑19), currently no effective drug or vaccine is available. This necessity motivated us to explore potential lead compounds by considering drug repurposing approach targeting main protease (Mpro) enzyme of SARS‑CoV‑2. This enzyme considered to be an attractive drug target as it contributes significantly in mediating viral replication and transcription. Herein, comprehensive computational investigations were performed to identify potential inhibitors of SARS‑CoV‑2 Mpro enzyme. The structure‑based pharmacophore modeling was developed based on the co‑crystallized structure of the enzyme with its biological active inhibitor. The generated hypotheses were applied for virtual screening based PhaseScore. Docking based virtual screening workflow was used to generate hit compounds using HTVS, SP and XP based Glide GScore. The pharmacological and physicochemical properties of the selected lead compounds were characterized using ADMET. Molecular dynamics simulations were performed to explore the binding affinities of the considered lead compounds. Binding energies revealed that compound ABBV‑744 binds to the Mpro with strong affinity (ΔGbind −45.43 kcal/mol), and the complex is more stable in comparison with other protein–ligand complexes. Our study classified three best compounds which could be considered as promising inhibitors against main protease SARS‑CoV‑2 virus
Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa
(2022-10-05) Michel Garenne
The study investigates the statistical relationship between male circumcision and HIV prevalence in Africa, in the context of the Voluntary Medical Male Circumcision (VMMC) campaigns in place since 2008. Data from the Population-based HIV Impact Assessment (PHIA) surveys conducted in African countries in 2017-2018 were utilized. Six countries with high HIV prevalence, low traditional circumcision and large VMMC programs were selected: Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe. The statistical analysis investigated the relative risk (RR) of HIV prevalence by circumcision status (circumcised vs intact) among men age 20-59, and the age-incidence of HIV in the two groups among men age 20-49, defined as the linear-logistic slope of the relationship between prevalence and age. Results show that the standardized RR was not different from 1 at older ages (50-59): RR = 0.923, 95% CI = 0.769-1.108, P = 0.390. Furthermore, the age-incidence was at least as high or higher among the circumcised groups than among the intact groups. The standardized RR was lower than 1 at younger ages, and this could be explained by selection biases. HIV prevalence at age 40-59 (27.3%) was also the same in the four groups of circumcision status (intact, traditional, medical, unknown). Results matched earlier observations made in South Africa that circumcised and intact men had similar levels of HIV infection. The study questions the current strategy of large scale VMMC campaigns to control the HIV epidemic. These campaigns also raise a number of ethical issues
All-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone: a prospective cohort study
(2023-02-05) Olivia Farrant; Mamadu Baldeh; Joseph Baio Kamara; Emma Bailey; Stephen Sevalie; Gibrilla Deen; James Baligeh Walter Russell; Daniel Youkee; Andy JM Leather; Justine Davies; Sulaiman Lakoh
Objectives To study the mortality of patients with COVID-19 in Sierra Leone, to explore the factors associated with mortality during the COVID-19 pandemic and to highlight the complexities of treating patients with a novel epidemic disease in a fragile health system. Study design A prospective single-centre cohort study. Data were extracted from paper medical records and transferred onto an electronic database. Specific indicators were compared between survivors and non-survivors, using descriptive statistics in Stata V.17. Study setting The infectious diseases unit (IDU) at Connaught Hospital in Freetown, Sierra Leone Participants Participants were all patients admitted to the IDU between March and July 2020. Aims of study The primary outcome of the study was to examine the all-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone and the secondary outcome measures were to examine factors associated with mortality in patients positive for COVID-19. Results 261 participants were included in the study. Overall, 41.3% of those admitted to the IDU died, compared with prepandemic in-hospital mortality of 23.8%. Factors contributing to the higher mortality were COVID-19 infection (aOR 5.61, 95% CI 1.19 to 26.30, p=0.02) and hypertension (aOR 9.30, 95% CI 1.18 to 73.27, p=0.03) Conclusions This study explores the multiple factors underpinning a doubling in facility mortality rate during the COVID-19 pandemic in Sierra Leone . It provides an insight into the realities of providing front-line healthcare during a pandemic in a fragile health system.
Antiplatelet Therapy Combined with Anastrozole Induces Features of Partial EMT in Breast Cancer Cells and Fails to Mitigate Breast-Cancer Induced Hypercoagulation
(MDPI, 2021-04-16) Xulu, Kutlwano R.; Augustine, Tanya N.
Thromboembolic complications are a leading cause of morbidity and mortality in cancer patients. Cancer patients often present with an increased risk for thrombosis including hypercoagulation, so the application of antiplatelet strategies to oncology warrants further investigation. This study investigated the effects of anastrozole and antiplatelet therapy (aspirin/clopidogrel cocktail or atopaxar) treatment on the tumour responses of luminal phenotype breast cancer cells and induced hypercoagulation. Ethical clearance was obtained (M150263). Blood was co-cultured with breast cancer cell lines (MCF7 and T47D) pre-treated with anastrozole and/or antiplatelet drugs for 24 h. Hypercoagulation was indicated by thrombin production and platelet activation (morphological and molecular). Gene expression associated with the epithelial-to-mesenchymal transition (EMT) was assessed in breast cancer cells, and secreted cytokines associated with tumour progression were evaluated. Data were analysed with the PAST3 software. Our findings showed that antiplatelet therapies (aspirin/clopidogrel cocktail and atopaxar) combined with anastrozole failed to prevent hypercoagulation and induced evidence of a partial EMT. Differences in tumour responses that modulate tumour aggression were noted between breast cancer cell lines, and this may be an important consideration in the clinical management of subphenotypes of luminal phenotype breast cancer. Further investigation is needed before this treatment modality (combined hormone and antiplatelet therapy) can be considered for managing tumour associated-thromboembolic disorder.
Aqueous extract of moringa (Moringa oleifera) leaf (AEMOL) on the growth, sensory and histology parameters of broiler chickens
(ALÖKI Kft, 2020-07) Mbajiorgu, Ejikeme F.; Alabi, O. J.; Ng’Ambi, J. W.
A completely randomized design experiment was used to determine the effects of aqueous extract of Moringa oleifera leaf (AEMOL) on growth, sensory and histology parameters of broiler chickens. Treatment 1 served as the control (antibiotics), Treatment two was given ordinary water (AEMOL0). Treatments 3, 4, 5 and 6 contained 30, 60, 90 and 120 ml of AEMOL per litre of water per day, respectively. Data obtained were analyzed using one-way analysis of variance and mean separation was done using Duncan’s test for multiple comparisons. Results showed that the extract influenced (P < 0.05) the feed intake and water intake at the broiler starter phase WHILE birds on the control diet had higher values. Finisher phase results showed that final weight, weight gain, feed intake, FCR and water intake were influenced (P < 0.05) by the extract with birds treated with 60 ml/l of AEMOL doing better for most parameters except the FCR. All the digestibility and sensory parameters measured were also influenced (P < 0.05) by the extract. However, histological parameters measured were not affected (P > 0.05) by the extract. It could be concluded that the extract inclusion levels up to 90 ml/l can be used to replace antibiotic growth promoter without compromising the advantages of antibiotic growth promoter.
Blood pressure measurements in the ankle are not equivalent to blood pressure measurements in the arm
(2014-12) Goldstein, L.N.; Wells, M.; Sliwa, K.
Background. Blood pressure (BP) is often measured on the ankle in the emergency department (ED), but this has never been shown to be an acceptable alternative to measurements performed on the arm. Objective. To establish whether the differences between arm and ankle non-invasive BP measurements were clinically relevant (i.e. a difference of ≥10 mmHg). Methods. This was a prospective cross-sectional study in an urban ED making use of a convenience sample of 201 patients (18 - 50 years of age) who were not in need of emergency medical treatment. BP was measured in the supine position on both arms and ankles with the correct size cuff according to the manufacturer’s guidelines. The arm and ankle BP measurements were compared. Results. There was a clinically and statistically significant difference between arm and ankle systolic BP (SBP) and mean arterial pressure (MAP) (–13 mmHg, 95% confidence interval (CI) –28 - 1 mmHg and –5 mmHg, 95% CI –13 - 4 mmHg, respectively), with less difference in diastolic BP (DBP) (2 mmHg, 95% CI –7 - 10 mmHg). Only 37% of SBP measurements and 83% of MAP measurements were within an error range of 10 mmHg, while 95% of DBP measurements agreed within 10 mmHg. While the average differences (or the bias) were generally not large, large variations in individual patients (indicating poor precision) made the prediction of arm BP from ankle measurements unreliable. Conclusion. Ankle BP cannot be used as a substitute for arm BP in the ED.
Cardiometabolic disease risk factors in pre- and postmenopausal women from four sub-Saharan African countries: A cross-sectional study
(2023-06) Raylton P. Chikwati; Nasrin Goolam Mahyoodeen; Nicole G. Jaff; Michele Ramsay; Lisa K. Micklesfield; Alisha N. Wade; Godfred Agongo; Gershim Asik; Solomon S.R. Choma; Palwende R. Boua; Jaya A. George; Nigel J. Crowther
Objective: To compare the risk factors for cardiometabolic disease between pre- and postmenopausal women from four sub-Saharan African countries. Study design: This cross-sectional study included 3609 women (1740 premenopausal and 1869 postmenopausal) from sites in Ghana (Navrongo), Burkina Faso (Nanoro), Kenya (Nairobi), and South Africa (Soweto and Dikgale). Demographic, anthropometric and cardiometabolic variables were compared between pre- and postmenopausal women, within and across sites using multivariable regression analyses. The sites represent populations at different stages of the health transition, with those in Ghana and Burkina Faso being rural, whilst those in Kenya and South Africa are more urbanised. Main outcome measures: Anthropometric and cardiometabolic variables. Results: The prevalence rates of risk factors for cardiometabolic disease were higher in South (Soweto and Dikgale) and East (Nairobi) Africa than in West Africa (Nanoro and Navrongo), irrespective of menopausal status. Regression models in combined West African populations demonstrated that postmenopausal women had a larger waist circumference (β = 1.28 (95 % CI: 0.58; 1.98) cm), log subcutaneous fat (β =0.15 (0.10; 0.19)) diastolic (β = 3.04 (1.47; 4.62) mm Hg) and log systolic (β = 0.04 (0.02; 0.06)) blood pressure, log carotid intima media thickness (β = 0.03 (0.01; 0.06)), low-density lipoprotein cholesterol (β = 0.14 (0.04; 0.23) mmol/L) and log triglyceride (β= 0.10 (0.04; 0.16)) levels than premenopausal women. No such differences were observed in the South and East African women. Conclusions: Menopause-related differences in risk factors for cardiometabolic disease were prominent in West but not East or South African study sites. These novel findings should inform cardiometabolic disease prevention strategies in midlife women specific to rural and urban and peri-urban locations in sub-Saharan Africa.
Changing relationships between HIV prevalence and circumcision in Lesotho
(2023-04-04) Michel Garenne
The study investigates the complex relationships between circumcision and HIV prevalence in Lesotho, using Demographic and Health surveys (DHS) conducted in 2004, 2009 and 2014. Before the HIV epidemic, about half of the male adult population was circumcised as part of a traditional custom, and this proportion increased markedly after 2008 with the campaigns of Voluntary Medical Male Circumcision (VMMC), while HIV prevalence stayed at the same level. In 2004, HIV prevalence was higher in circumcised groups than in intact groups (RR=1.49, 95% CI=1.20-1.86). This relationship changed over time, and was inversed in 2014 (RR=0.86; 95% CI=0.70-1.06). The changing relationship seems to be due to an interaction with education, with more educated men being more circumcised and having less HIV over time. A multivariate analysis showed no net effect of circumcision on HIV, after controlling for wealth, education, and indicators of marriage and sexual behaviour. A small net effect of VMMC was found, probably due to condom use. In couple studies, the effect of circumcision and VMMC on HIV was not significant, with similar transmission from female to male and male to female. The study questions the amount of effort and money spent on VMMC in Lesotho.
Cohort Profile: Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI).
(2018) F Xavier Go´ mez-Olive´; Livia Montana; Ryan G Wagner; Chodziwadziwa W Kabudula; Julia K Rohr; Kathleen Kahn; Till Ba¨rnighausen; Mark Collinson; David Canning; Thomas Gaziano; Joshua A Salomon; Collin F Payne; Alisha Wad; Stephen M Tollman; Lisa Berkman
Community Health Worker Use of Smart Devices for Health Promotion: Scoping Review
(2023-02-25) Merlin Greuel1 , BA, MGH, MD; Frithjof Sy1 , BSc, MD; Till Bärnighausen1,2,3 , MSc, MD, SCD; Maya Adam1,4 , BA, MD; Alain Vandormael1 , MSc, PhD; Jennifer Gates5 , BA; Guy Harling2,6,7,8,9 , BSc, MA, MPH, SCD
Background: Community health workers (CHWs) have become essential to the promotion of healthy behaviors, yet their work is complicated by challenges both within and beyond their control. These challenges include resistance to the change of existing behaviors, disbelief of health messages, limited community health literacy, insufficient CHW communication skills and knowledge, lack of community interest and respect for CHWs, and CHWs’ lack of adequate supplies. The rising penetration of “smart” technology (eg, smartphones and tablets) in low- and middle-income countries facilitates the use of portable electronic devices in the field. Objective: This scoping review examines to what extent mobile health in the form of smart devices may enhance the delivery of public health messages in CHW-client interactions, thereby addressing the aforementioned challenges and inducing client behavior change. Methods: We conducted a structured search of the PubMed and LILACS databases using subject heading terms in 4 categories: technology user, technology device, use of technology, and outcome. Eligibility criteria included publication since January 2007, CHWs delivering a health message aided by a smart device, and face-to-face communication between CHWs and clients. Eligible studies were analyzed qualitatively using a modified version of the Partners in Health conceptual framework. Results: We identified 12 eligible studies, 10 (83%) of which used qualitative or mixed methods approaches. We found that smart devices mitigate challenges encountered by CHWs by improving their knowledge, motivation, and creativity (eg, through self-made videos); their status within the community; and the credibility of their health messages. The technology stimulated interest in both CHWs and clients—and sometimes even in bystanders and neighbors. Media content produced locally or reflecting local customs was strongly embraced. Yet, the effect of smart devices on the quality of CHW-client interactions was inconclusive. Interactions suffered as CHWs were tempted to replace educational conversations with clients by passively watching video content. Furthermore, a series of technical difficulties experienced especially by older and less educated CHWs compromised some of the advantages brought about by mobile devices. Adequate CHW training ameliorated these difficulties. Only 1 study (8%) considered client health behavior change as an end point, thus revealing a major research gap. Conclusions: Smart mobile devices may augment CHWs’field performance and enhance face-to-face interactions with clients, yet they also generate new challenges. The available evidence is scarce, mostly qualitative, and focused on a limited range of health outcomes. Future research should include larger-scale interventions across a wide range of health outcomes and feature client health behavior change as an end point.
Consensus study on factors influencing the academic entrepreneur in a middle income country's university enterprise
Farrell, Alfred; Ashton, James ; Mapanga, Witness; Joffe, Maureen; Chitha, N.; Beksinska, M.; Chitha, Wezile; Coovadia, Ashraf; Cutland, Clare; Drennan, Robin; Kahn, Kathleen; Koekemoer, Lizette; Micklesfield, Lisa; Miot, Jacqueline; Naidoo, Julian; Papathanasopoulos, Maria; Sive, Warrick; Smit, J.; Tollman, Stephen; Veller, Martin; Ware, Lisa; Wing, Jefferey; Norris, Shane
Purpose– This study aims to ascertain the personal characteristics of a group of successful academic entrepreneurs in a South African university enterprise and the prevalent barriers and enablers to their entrepreneurial endeavour. Design/methodology/approach– The authors used a Delphi process to identify and rank the characteristics, enablers, barriers and behaviours of entrepreneurial academics, with a Nominal Group Technique applied to establish challenges they encounter managing their enterprise and to propose solutions. Findings– Perseverance, resilience and innovation are critical personal characteristics, while collaborative networks, efficient research infrastructure and established research competence are essential for success. The university’s support for entrepreneurship is a significant enabler, with unnecessary bureaucracy and poor Purpose– This study aims to ascertain the personal characteristics of a group of successful academic entrepreneurs in a South African university enterprise and the prevalent barriers and enablers to their entrepreneurial endeavour. Design/methodology/approach– The authors used a Delphi process to identify and rank the characteristics, enablers, barriers and behaviours of entrepreneurial academics, with a Nominal Group Technique applied to establish challenges they encounter managing their enterprise and to propose solutions. Findings– Perseverance, resilience and innovation are critical personal characteristics, while collaborative networks, efficient research infrastructure and established research competence are essential for success. The university’s support for entrepreneurship is a significant enabler, with unnecessary bureaucracy and poorPurpose– This study aims to ascertain the personal characteristics of a group of successful academic entrepreneurs in a South African university enterprise and the prevalent barriers and enablers to their entrepreneurial endeavour. Design/methodology/approach– The authors used a Delphi process to identify and rank the characteristics, enablers, barriers and behaviours of entrepreneurial academics, with a Nominal Group Technique applied to establish challenges they encounter managing their enterprise and to propose solutions. Findings– Perseverance, resilience and innovation are critical personal characteristics, while collaborative networks, efficient research infrastructure and established research competence are essential for success. The university’s support for entrepreneurship is a significant enabler, with unnecessary bureaucracy and poor access to project and general enterprise funding an impediment. Successful academic entrepreneurs have strong leadership, and effective management and communication skills. Research limitations/implications– The main limitation is the small study participant group drawn from a single university enterprise, which complicates general disability. The study supported the use of Krueger’s (2009) entrepreneurial intentions model for low- and middle-income country (LMIC) academic entrepreneur investigation but proposed the inclusion of mitigators to entrepreneurial activation to recognise contextual deficiencies and challenges. Practical implications– Skills-deficient LMIC universities should extensively and directly support their entrepreneurial academics to overcome their contextual deficiencies and challenging environment. Originality/value– This study contributes to addressing the paucity of academic entrepreneur research in LMIC contexts by identifying LMIC-specific factors that inhibit the entrepreneur’s movement from entrepreneurial intention to entrepreneurial action.
Consensus study on factors influencing the academic entrepreneur in a middle-income country’s university enterprise
(2023-05-20) Alfred Austin Farrell; James Ashton; WitnessMapanga; Maureen Joffe; Nombulelo Chitha; Mags Beksinska; Wezile Chitha; Ashraf Coovadia; Clare L. Cutland; RobinL. Drennan; Kathleen Kahn; Lizette L. Koekemoer; Lisa K.Micklesfield; JacquiMiot; Julian Naidoo; Maria Papathanasopoulos; Warrick Sive; Jenni Smit; StephenM. Tollman; Martin G. Veller; Lisa J.Ware; Jeffrey Wing; Shane A. Norris
Purpose – This study aims to ascertain the personal characteristics of a group of successful academic entrepreneurs in a South African university enterprise and the prevalent barriers and enablers to their entrepreneurial endeavour. Design/methodology/approach – The authors used a Delphi process to identify and rank the characteristics, enablers, barriers and behaviours of entrepreneurial academics, with a Nominal Group Technique applied to establish challenges they encounter managing their enterprise and to propose solutions. Findings – Perseverance, resilience and innovation are critical personal characteristics, while collaborative networks, efficient research infrastructure and established research competence are essential for success. The university’s support for entrepreneurship is a significant enabler, with unnecessary bureaucracy and poor access to project and general enterprise funding an impediment. Successful academic entrepreneurs have strong leadership, and effective management and communication skills. Research limitations/implications – The main limitation is the small study participant group drawn from a single university enterprise, which complicates generalisability. The study supported the use of Krueger’s (2009) entrepreneurial intentions model for low- and middle-income country (LMIC) academic entrepreneur investigation but proposed the inclusion of mitigators to entrepreneurial activation to recognize contextual deficiencies and challenges.
Critical value reporting : a survey of 36 clinical laboratories in South Africa
(2014-01) Schapkaitz, E.; Mafika, Z.
Objective: Critical value policies are used by clinical laboratories to decide when to notify caregivers of life-threatening results. Despite their widespread use, critical value policies have not been published locally. A survey was designed to determine critical value policies for haematology tests in South Africa. Methods: A survey was carried out on 136 identified laboratories across South Africa in January 2013. Of these, 36 responded. Data collected included critical value policies, critical values for haematology parameters, and critical value reporting. Results: Of the 36 laboratories surveyed, 11.1% (n=4) were private, 33.3% (n=12) were affiliated to academic institutions and 55.6% (n=20) were peripheral or regional National Health Laboratory Service laboratories. All the laboratories confirmed that they had a critical value policy, and 83.3% of such policies were derived from local clinical opinion. Mean low and high critical limits for the most frequently listed tests were as follows: haemoglobin <6 and >20 g/dl, platelet count <41 and >1 000 ×109 /l, white cell count <2 and >46×109 /l, activated partial thromboplastin time >101 seconds, and international normalised ratio >6. In almost all cases critical value reporting was performed by the technologist on duty (97.2%). The majority of laboratories required that the person notified of the critical value be the doctor who ordered the test or the caregiver directly involved in the patient’s care (83.3%); 73.3% of laboratories indicated that they followed an algorithm if the doctor/caregiver could not be reached. Conclusion: Each laboratory is responsible for establishing clinically relevant critical limits. Clinicians should be involved in developing the laboratory’s critical value policy. The findings of this survey may be of value to local laboratories that are in the process of establishing or reviewing critical value policies
Development of the Wits Face Database: an African database of high-resolution facial photographs and multimodal closedcircuit television (CCTV) recordings [version 1; peer review: 2 approved]
(2021) Bacci, Nicholas; Davimes, Joshua; Steyn, Maryna; Briers, Nanette
Forensic facial comparison is a commonly used, yet under-evaluated method employed in medicolegal contexts across the world. Testing the accuracy and reliability of facial comparisons requires large scale controlled and matching facial image databases. Databases that contain images of individuals on closed-circuit television (CCTV), with matching formal and informal photographs are needed for this type of research. Although many databases are available, the majority if not all are developed in order to improve facial recognition and face detection algorithms through machine learning, with very limited if any measure of standardisation. This paper aims to review the available databases and describe the development of a high resolution, standardised facial photograph and CCTV recording database of male Africans. The database is composed of a total of 6220 standardised and uncontrolled suboptimal facial photographs of 622 matching individuals in five different views, as well as corresponding CCTV footage of 334 individuals recorded under different realistic conditions. A detailed description of the composition and acquisition process of the database as well as its subdivisions and possible uses are provided. The challenges and limitations of developing this database are also highlighted, particularly with regard to obtaining CCTV video recordings and ethics for a database of faces. The application process to access the database is also briefly described.
Epidemiology of chronic multimorbidity and temporary migration in a rural South African community in health transition: A cross-sectional population-based analysis
(2023-04-21) Armstrong Dzomba; Carren Ginsburg; Chodziwadziwa W. Kabudula; Rachel R. Yorlets; Pedzisai Ndagurwa; Sadson Harawa; Mark N. Lurie; Stephen T. McGarvey; Stephen Tollman; Mark A. Collinson; Michael J. White; Francesc X. Gomez-Olive
Introduction: In sub-Saharan African settings, the increasing non-communicable disease mortality is linked to migration, which disproportionately exposes subpopulations to risk factors for co-occurring HIV and NCDs. Methods: We examined the prevalence, patterns, and factors associated with two or more concurrent diagnoses of chronic diseases (i.e., multimorbidity) among temporary within-country migrants. Employing a cross-sectional design, our study sample comprised 2144 residents and non-residents 18–40 years interviewed and with measured biomarkers in 2018 in Wave 1 of the Migrant Health Follow-up Study (MHFUS), drawn from the Agincourt Health and Demographic Surveillance System (AHDSS) in rural north-eastern South Africa. We used modified Poisson regression models to estimate the association between migration status and prevalent chronic multimorbidity conditional on age, sex, education, and healthcare utilisation. Results: Overall, 301 participants (14%; 95% CI 12.6–15.6), median age 31 years had chronic multimorbidity. Multimorbidity was more prevalent among non-migrants (14.6%; 95% CI 12.8–16.4) compared to migrants (12.8%; 95% CI 10.3–15.7). Nonmigrants also had the greatest burden of dual-overlapping chronic morbidities, such as HIV-obesity 5.7%. Multimorbidity was 2.6 times as prevalent (PR 2.65. 95% CI 2.07– 3.39) among women compared to men. Among migrants, men, and individuals with secondary or tertiary education manifested lower prevalence of two or more conditions. Discussion: In a rural community with colliding epidemics, we found low but significant multimorbidity driven by a trio of conditions: HIV, hypertension, and obesity. Understanding the multimorbidity burden associated with early adulthood exposures, including potential protective factors (i.e., migration coupled with education), is a critical first step towards improving secondary and tertiary prevention for chronic disease among highly mobile marginalised sub-populations.
Estimating population level 24-h sodium excretion using spot urine samples in older adults in rural South Africa
(2023-02-01) Jacques D. Du Toita; David Kapaonb; Nigel J. Crowtherc; Shafika Abrahams-Gessele; June Fabian; Chodziwadziwa W. Kabudula; Alisha N. Wade; Stephen Tollman; Thomas A. Gaziano
Background: South Africa has introduced regulations to reduce sodium in processed foods. Assessing salt consumption with 24-h urine collection is logistically challenging and expensive. We assess the accuracy of using spot urine samples to estimate 24-h urine sodium (24hrUNa) excretion at the population level in a cohort of older adults in rural South Africa. Methods: 24hrUNa excretion was measured and compared to that estimated from matched spot urine samples in 399 individuals, aged 40–75 years, from rural Mpumalanga, South Africa.We used the Tanaka, Kawasaki, International Study of Sodium, Potassium, and Blood Pressure (INTERSALT), and Population Mean Volume (PMV) method to predict 24hrUNa at the individual and population level. Results: The population median 24hrUNa excretion from our samples collected in 2017 was 2.6 g (interquartile range: 1.53–4.21) equal to an average daily salt intake of 6.6 g, whereas 65.4% of participants had a salt excretion above the WHO recommended 5 g/day. Estimated population median 24hrUNa derived from the INTERSALT, both with and without potassium, showed a nonsignificant difference of 0.25 g (P = 0.59) and 0.21 g (P = 0.67), respectively. In contrast, the Tanaka, Kawasaki, and PMV formulas were markedly higher than the measured 24hrUNa, with a median difference of 0.51 g (P = 0.004), 0.99 g (P = 0.00), and 1.05 g (P = 0.00) respectively. All formulas however performed poorly when predicting an individual’s 24hrUNa, Conclusion: In this population, the INTERSALT formulas are a well suited and cost-effective alternative to 24-h urine collection for the evaluation of population median 24hrUNa excretion. This could play an important role for governments and public health agencies in evaluating local salt regulations and identifying at-risk populations.
Executive function and pre-academic skills in preschoolers from South Africa
(2023-08-25) Caylee J. Cook; Steven Howard; Gaia Scerif; Rhian Twine; Kathleen Kahn; Shane Norris; Catherine Draper
Background: While there is now considerable evidence in support of a relationship between executive function (EF) and academic success, these findings almost uniformly derive from Western and high-income countries. Yet, recent findings from low- to middle- income countries have suggested that patterns of EF and academic skills differ in these contexts, but there is little clarity on the extent, direction and nature of their association. Aim: This study aimed to investigate the contribution of EF to pre-academic skills in a sample of preschool children (N = 124; Mage = 50.91 months; 45% female). Setting: Two preschools were recruited from an urban setting in a community with both formal and informal housing, overcrowding, high levels of crime and violence, and poor service delivery. Three preschools were recruited from rural communities with household plots, a slow rate of infrastructure development, reliance on open fires for cooking, limited access to running water and rudimentary sanitation. Methods: Pre-academic skills were assessed using the Herbst Early Childhood Development Criteria test, and EF was assessed using the Early Years Toolbox. Results: Although EF scores appeared high and pre-academic skills were low (in norm comparisons), EF inhibition (ß = 0.23, p = 0.001) and working memory (ß = 0.25, p < 0.001) nevertheless showed strong prediction of pre-academic skills while shifting was not significant. Conclusion: While EF is an important predictor of pre-academic skills even in this low- and middle-income country context, factors in addition to EF may be equally important targets to foster school readiness in these settings. Contribution: The current study represents a first step towards an understanding of the current strengths that can be leveraged, and opportunities for additional development, in the service of preparing all children for the demands of school.
Exploring the perception of and attitude towards preconception care service provision and utilisation in a South Western Nigerian community – a qualitative study
(School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, 2021-02) Ojifinni, Oludoyinmola O.; Munyewende, Pascalia O.; Ibisomi, Latifat
Background: Hospital-based, quantitative studies in Nigeria show low levels of knowledge and use of preconception care (PCC) services. This study explored the perception of and attitude towards PCC in a southwestern Nigerian community qualitatively. Data Source and Methods: Focus group discussions (FGDs) were held with 57 purposively selected adult women and men and key informant interviews (KIIs) with one female and one male community leader in Ibadan North Local Government Area, Oyo State, Nigeria in 2018. The FGDs and KIIs held within the community were digitally recorded, transcribed verbatim and analysed thematically. Results: Participants placed PCC in the context of marriage, describing its importance for addressing effects of adverse exposures on pregnancy and ensuring positive pregnancy outcomes. Conclusion: Barriers to PCC uptake mentioned included lack of awareness and prohibitive service costs. Expressing their willingness to use and promote PCC use, they stated the need to ensure PCC uptake through improved awareness at the community level.
Feasibility of an online consensus approach for the diagnosis of cognitive impairment and dementia in rural South Africa
(2023-03-04) Darina T. Bassil; Meagan T. Farrell; AlbertWeerman; Muqi Guo; Ryan G.Wagner; AdamM. Brickman; M. Maria Glymour; Kenneth M. Langa; Jennifer J. Manly; Brent Tipping; India Butler; Stephen Tollman; Lisa F. Berkman
INTRODUCTION:We describe the development and feasibility of using an online consensus approach for diagnosing cognitive impairment and dementia in rural South Africa. METHODS: Cognitive assessments, clinical evaluations, and informant interviews from Cognition and Dementia in the Health and Aging in Africa Longitudinal Study (HAALSI Dementia) were reviewed by an expert panel using a web-based platform to assign a diagnosis of cognitively normal, mild cognitive impairment (MCI), or dementia. RESULTS: Six hundred thirty-five participants were assigned a final diagnostic category, with 298 requiring adjudication conference calls. Overall agreement between each rater’s independent diagnosis and final diagnosis (via the portal or consensus conference) was 78.3%. A moderate level of agreement between raters’ individual ratings and the final diagnostic outcomes was observed (average κ coefficient = 0.50).DISCUSSION: Findings show initial feasibility in using an online consensus approach for the diagnosis of cognitive impairment and dementia in remote, rural, and lowresource settings.
Forensic facial comparison: current status, limitations, and future directions.
(MDPI, 2021-12-03) Bacci, Nicholas; Davimes, Joshua G.; Steyn, Maryna; Briers, Nanette
Global escalation of crime has necessitated the use of digital imagery to aid the identification of perpetrators. Forensic facial comparison (FFC) is increasingly employed, often relying on poorquality images. In the absence of standardized criteria, especially in terms of video recordings, verification of the methodology is needed. This paper addresses aspects of FFC, discussing relevant terminology, investigating the validity and reliability of the FISWG morphological feature list using a new South African database, and advising on standards for CCTV equipment. Suboptimal conditions, including poor resolution, unfavorable angle of incidence, color, and lighting, affected the accuracy of FFC. Morphological analysis of photographs, standard CCTV, and eye-level CCTV showed improved performance in a strict iteration analysis, but not when using analogue CCTV images. Therefore, both strict and lenient iterations should be conducted, but FFC must be abandoned when a strict iteration performs worse than a lenient one. This threshold ought to be applied to the specific CCTV equipment to determine its utility. Chance-corrected accuracy was the most representative measure of accuracy, as opposed to the commonly used hit rate. While the use of automated systems is increasing, trained human observer-based morphological analysis, using the FISWG feature list and an Analysis, Comparison, Evaluation, and Verification (ACE-V) approach, should be the primary method of facial comparison.

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