In low‐resource settings, there is a need to develop models that can address contributions of household and outdoor sources to population exposures. The aim of the study was to model indoor PM2.5 ...using household characteristics, activities, and outdoor sources. Households belonging to participants in the Mother and Child in the Environment (MACE) birth cohort, in Durban, South Africa, were randomly selected. A structured walk‐through identified variables likely to generate PM2.5. MiniVol samplers were used to monitor PM2.5 for a period of 24 hours, followed by a post‐activity questionnaire. Factor analysis was used as a variable reduction tool. Levels of PM2.5 in the south were higher than in the north of the city (P < .05); crowding and dwelling type, household emissions (incense, candles, cooking), and household smoking practices were factors associated with an increase in PM2.5 levels (P < .05), while room magnitude and natural ventilation factors were associated with a decrease in the PM2.5 levels (P < .05). A reasonably robust PM2.5 predictive model was obtained with model R2 of 50%. Recognizing the challenges in characterizing exposure in environmental epidemiological studies, particularly in resource‐constrained settings, modeling provides an opportunity to reasonably estimate indoor pollutant levels in unmeasured homes.
Background The immunohistochemical (IHC) detection of myelocytomatosis oncogene (MYC) is a crucial step in the diagnosis and prognosis of Burkitt lymphoma (BL). Sections of the MYC protein are ...routinely used as tags in protein precipitation experiments to assist with the isolation of proteins without antibodies. However, it is unknown if the tag antibodies can also be used for BL diagnosis. Aim This project aimed to determine whether the MYC tag 9E10 antibody can be used to detect MYC overexpression because of MYC translocation in BL cases. Setting Charlotte Maxeke Johannesburg Academic Hospital, South Africa. Methods Immunohistochemical staining for 9E10 was optimised and used to stain 10 BL with known MYC translocation status to calculate sensitivity, specificity and predictive values. Results Staining of the BL cases generally produced a 'very weak' (70%) and weak-moderate (18.2%) staining patterns with a staining extent of 1+ (36%) and 3+ (27%). Of the 10 samples, 6 (60%) showed a positive MYC protein expression by IHC. In comparison, 7 (70%) samples indicated MYC gene rearrangements. There were 5 (50%) cases with both MYC IHC expression and gene translocations and 2 (20%) cases that were negative for both MYC IHC and gene rearrangements. Conclusion The authors demonstrate that the 9E10 MYC tagged antibody may be used to detect MYC gene expression with a sensitivity of 71% and a specificity of 67%. In addition, the positive predictive value (PPV) and negative predictive value (NPV) varied according to IHC staining cut-offs. Immunohistochemical expression does not perfectly correlate with translocation status because of inconsistencies with IHC interpretation. Contribution MYC gene rearrangements are present in nearly all BL cases. Finding more affordable and convenient ways to predict the presence of MYC gene rearrangements is of utmost importance, given the lack of financial resources in our continent. This study shows that the 9E10 antibody, commonly used in protein tagging experiments, may also be used to predict MYC gene rearrangements in BL.
A changing climate is likely to have widespread and varying impacts on ecosystems and human health. South Africa (SA) is particularly vulnerable to the impacts of climate change, given the projected ...increases in temperature, and changes in the amount and patterns of rainfall. Moreover, SA's vulnerability is exacerbated by extreme inequality and poverty. To prepare for the impacts of climate change and to ensure timeous adaptation, a perspective is given on essential heat and health research in the country. Objectives. To gather studies conducted by the South African Medical Research Council (SAMRC)'s Environment and Health Research Unit (EHRU) to illustrate the range of possible research key areas in the climate, heat and health domain and to present future research priorities. Methods. Studies conducted by the SAMRC's EHRU were gathered and used to illustrate the range of possible research key areas in the climate, heat and health domain. Using national and international published and grey literature, and tapping into institutional research experiences, an overview of research findings to date and future research priorities were developed. Results. Heat and health-related research has focussed on key settings, for example, schools, homes and outdoor work places, and vulnerable groups such as infants and children, the elderly and people with pre-existing diseases. The need to address basic needs and services provision was emphasised as an important priority. Conclusions. High and low temperatures in SA are already associated with mortality annually; these impacts are likely to increase with a changing climate. Critical cross-sectoral research will aid in understanding and preparing for temperature extremes in SA.
To highlight legal and regulatory advances relating to South African traditional health practitioners (THPs) over the past 10 years and discuss the implications for the translation of health policies ...into guidelines for sustainable practice supporting public health.
This is a rapid, structured literature review.
A rapid, structured literature review was undertaken to identify relevant studies related to South African THPs involving a search of peer-reviewed literature from three databases and a grey literature internet search. The identified citations were screened, critically appraised, and narratively synthesized.
Efforts to regulate THPs in South Africa are underway; however, the lack of a regulatory framework for traditional practices is hampering progress. Several efforts to collaborate with THPs have been made over the years, many of which were not systematically evaluated and not based on principles of mutual respect. Existing collaborative examples need to be further supported by cost-effective evidence to suit the South African public health budget. Furthermore, small collaborative research efforts do not take into consideration the scale up of interventions.
THPs in South Africa represent an important healthcare resource. However, the current policy environment does not support indicators to describe, monitor, and/or evaluate the role of THPs in the healthcare system.
•Regulation of traditional health practitioners (THPs) in South Africa is underway.•The number of THPs testifies to the importance and resilience of their practice.•Focused public health policies of THPs in health care are lacking.
Background and objectivesGlobally, contemporary legislation surrounding traditional health practitioners (THPs) is limited. This is also true for the member states of the Southern African Development ...Community (SADC). The main aim of this study is to map and review THP-related legislation among SADC countries. In order to limit the scope of the review, the emphasis is on defining THPs in terms of legal documents.MethodsThis scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews methods. Two independent reviewers reviewed applicable legal definitions of THPs by searching the Southern African Legal Information Institute (SAFLII) database in April 2018 for legislation and bills. To identify additional legislation applicable in countries not listed on SAFLII and/or further relevant SADC legislation, the search engines, Google and PubMed, were used in August 2018 and results were reviewed by two independent reviewers. Full texts of available policy and legal documents were screened to identify policies and legislation relating to the regulation of THPs. Legislation was deemed relevant if it was a draft of or promulgated legislation relating to THPs.ResultsFour of 14 Southern African countries have legislation relating to THPs. Three countries, namely South Africa, Namibia and Zimbabwe, have acknowledged the roles and importance of THPs in healthcare delivery by creating a council to register and formalise practices, although they have not operationalised nor registered and defined THPs. In contrast, Tanzania has established a definition couched in terms that acknowledge the context-specific and situational knowledge of THPs, while also outlining methods and the importance of local recognition. Tanzanian legislation; thus, provides a definition of THP that specifically operationalises THPs, whereas legislation in South Africa, Namibia and Zimbabwe allocates the power to a council to decide or recognise who a THP is; this council can prescribe procedures to be followed for the registration of a THP.ConclusionsThis review highlights the differences and similarities between the various policies and legislation pertaining to THPs in SADC countries. Legislation regarding THPs is available in four of the 14 SADC countries. While South Africa, Tanzania, Namibia and Zimbabwe have legislation that provides guidance as to THP recognition, registration and practices, THPs continue to be loosely defined in most of these countries. Not having an exact definition for THPs may hamper the promotion and inclusion of THPs in national health systems, but it may also be something that is unavoidable given the tensions between lived practices and rigid legalistic frameworks.
Globally, Traditional Medicine (TM) plays an important role in healthcare. In South Africa, attempts at regulation of Traditional Health Practitioners (THPs) began in 2007. Implementation efforts ...include the interim THP Council and proposed regulations. Amidst wide criticism, progress at ground-level is slow. To date, no THPs are registered. The aim of the study was to explore the perspectives of stakeholders on the local realities in relation to the regulation of THPs in order to capitalize on the challenges and opportunities both nationally and internationally.
Stakeholders were selected based on a prior stakeholder mapping study to participate in in-depth interviews. The stakeholders belonged to one of the following broad groups: 1) local government, 2) academic experts 3) traditional health practitioner associations or organisations 4) non-government organisations or consumer groups and 5) international organisation or donors. A framework analysis approach was used to arrive at four overarching themes.
Perceptions of key challenges and opportunities linked to the implementation of the THP Act are common across stakeholder groups, though with varied explanation. The four overarching themes within which challenges and opportunities were described are: 1) risk-benefit of regulation, 2) understanding, awareness, and paradigmatic opposition, 3) THP-centred research for sustained progress and coexistence, and 4) systemic disadvantage, stigma, and conflict.
Global recommendations are clear. However, a more comprehensive understanding of this landscape would lend itself to regulation and policy, truly compatible with the contextual realities. The researchers recommend THP-centred research and capacity-building for implementation and wider health-system benefit.
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