Background. Despite efforts to reduce self-harm mortality, death rates remain high, with almost 12% of all youth deaths in South Africa (SA) attributed to this cause. There are gendered differences ...in causes of death among youth, but little is known about the sex-specific risk factors. Objective. To identify the levels and sex-specific determinants of self-harm mortality among youth in SA. Methods. This was a cross-sectional study of SA death notification forms from 2006 to 2014. Descriptive and analytical statistical techniques were used, including cause-specific mortality rates, proportional mortality ratios and logistic regression models. Results. A total of 1 122 youth (15 - 24 years of age) deaths due to self-harm causes were reported over the study period, during which rates of self-harm mortality increased. More deaths of males (n=818) than females (n=304) were reported. Almost 60% of deaths (p<0.05) were of 20 - 24-year-olds, and 46.4% (p<0.05) of those who died had a secondary education. Almost 10% of females (p<0.05) were pregnant at the time of death. Hanging was the most common type of self-harm mortality among males (79.2%) and females (49.3%). While 11.0% (n=90) of self-harm deaths of males were due to poisoning, more females used this method (39.8%, n=121). The probability of self-harm mortality for males increased according to certain provinces of residence. For females the odds were higher for those who were pregnant (odds ratio (OR) 1.3; p<0.05) and non-South African (OR 1.7; p<0.05) and had secondary education (OR 1.4; p<0.05). Conclusions. The study showed gender differentials in the determinants of self-harm mortality among youth in SA. For this reason, uniform approaches to awareness campaigns need to be altered to address the specific needs of youth. While males have higher rates than females, the prevalence of self-harm mortality in pregnant females is of concern and needs to be addressed specifically, as it relates not only to suicidal ideation and behaviour but also to youth sexual and reproductive health programmes in the country.
Summary
Aim: To determine efficacy and safety of intravenous micafungin vs. intravenous fluconazole in the treatment of oesophageal candidiasis.
Methods: A total of 523 patients ≥16 years with ...documented oesophageal candidiasis were randomized (1:1) in this controlled, non‐inferiority study to receive either micafungin (150 mg/day) or fluconazole (200 mg/day). Response was evaluated clinically and endoscopically. Post‐treatment assessments were performed at 2 and 4 weeks after discontinuation of therapy.
Results: Median duration of therapy was 14 days. For the primary end‐point of endoscopic cure, treatment difference was −0.3% (micafungin 87.7%, fluconazole 88.0%). Documented persistent invasive disease at the end of therapy was reported in 2.7% and 3.9% of patients, respectively. Both 84.8% of micafungin and 88.7% of fluconazole patients remained recurrence free at 4‐weeks post‐treatment. The overall therapeutic response rate was 87.3% for micafungin and 87.2% for fluconazole. The incidence of drug‐related adverse events was 27.7% for micafungin and 21.3% for fluconazole. Six (2.3%) micafungin‐ and two (0.8%) fluconazole‐treated patients discontinued therapy; rash was the most common event leading to discontinuation.
Conclusion: Intravenous micafungin (150 mg daily) is well tolerated and as efficacious as intravenous fluconazole (200 mg daily) in the primary treatment of oesophageal candidiasis, achieving high rates of clinical and endoscopic cure.
Background. The KwaZulu-Natal (KZN) Province remains one of the provinces mostly affected by under-5 mortality in South Africa, despite the many programmes and policies implemented to prevent under-5 ...children from dying. Objective. To examine the association between socioeconomic and demographic factors and under-5 mortality in KZN. Methods. The study was cross-sectional and based on a secondary data set from the 2011 national census, conducted by Statistics South Africa. From the 10% sample, 1 474 under-5-year-olds had died in the province during the period of data collection. Statistical analysis was performed in Stata 12.0 and involved univariate, bivariate and multivariate analysis. Results. The results showed that maternal variables such as age, education level and race, as well as annual household income were predictors of under-5 mortality. Male children were also found to have a higher likelihood of dying before the age of 5 years than female children. Conclusion. The study identified several socioeconomic and demographic factors as predictors of under-5 mortality in KZN. The findings suggest the importance of up-scaling and strengthening interventions aimed at reducing under-5 mortality in the province, with specific focus on addressing the needs of young black women, those with limited education and women from poor households.
Background. Severely immunocompromised individuals are highly susceptible to Candida infection of the esophagus. This randomized, double-blind study assessed the dose-response relationship of the new ...echinocandin antifungal, micafungin, compared with that of standard fluconazole treatment. Methods. A total of 245 patients (age, ⩾18 years) with a prior diagnosis of acquired immunodeficiency syndrome/human immunodeficiency virus (HIV) infection and esophageal candidiasis, confirmed by endoscopy and culture, were randomized to receive micafungin (50, 100, or 150 mg per day) or fluconazole (200 mg per day). Both agents were administered once per day by a 1-h intravenous infusion for 14–21 days. The primary efficacy end point was endoscopic cure rate, defined as endoscopy grade of 0 at the end of therapy. Results. The endoscopic cure rate (grade 0) was dose-dependent with 50, 100, and 150 mg of micafungin per day at 68.8%, 77.4%, and 89.8%, respectively. Symptoms improved or resolved rapidly (3–7 days of treatment in the majority of patients). The endoscopic cure rate for 100 and 150 mg of micafungin per day (83.5%) was comparable to that for 200 mg of fluconazole per day (86.7%; 95% confidence interval for the difference in endoscopic cure rate, -14.0% to 7.7%). The overall safety and tolerability was acceptable, with no important differences between micafungin (all doses) and fluconazole. Conclusions. The dose-response findings demonstrate a greater efficacy with micafungin at 100 and 150 mg per day than at 50 mg per day. This study also indicates that the efficacy of micafungin (at dosages of 100 and 150 mg per day) was comparable to that of fluconazole, suggesting that micafungin represents a valuable new treatment option for esophageal candidiasis in HIV-positive patients.
Background. South Africa (SA)'s high adolescent fertility has been extensively studied. A pregnancy outcome that has not received sufficient attention in research is the causes of death among ...pregnant adolescents. Objectives. To examine levels and causes of adolescent maternal mortality in SA. Methods. A secondary data analysis of Death Notification Forms from 2006 to 2012 was carried out. SA General Household Surveys from 2006 to 2012 were used to ascertain the number of female adolescents in the population. Frequency distributions and life table techniques were employed. Results. An estimated 1 164 deaths have been recorded among pregnant adolescents between 2006 and 2012. Adolescent maternal and pregnancy-related mortality is lower than adult maternal and pregnancy-related mortality. The main causes of death among adolescents were hypertension (55.6% of all direct causes), abortion (17.6% of all indirect causes) and injuries (48.9% of all indirect causes). The probability of adolescents dying while pregnant without these causes is practically non-existent (range 0.002 - 0.150%). Conclusion. Policies and programmes should prioritise these pregnancy-related causes of death in order to further reduce such deaths among adolescents in SA. S Afr J Child Health 2016;10(3):151-155. DOI:10.7196/SAJCH.2016.v10i3.978
Background. Non-communicable diseases (NCDs) cause premature mortality among youth. Associated with lifestyle and behavioural choices, these diseases and deaths can and should be prevented among ...young people. This article presents data showing the gains in life expectancy among youth in the absence of NCD causes of death.Objectives. To estimate the levels of NCD mortality among youth (15 - 24 years of age) in South Africa (SA) and show the current and projected additional years of life gained with the elimination of heart disease, cancer and diabetes.Methods. This was a cross-sectional study using 20 years of death notification forms from SA (1997 - 2016). The data were nationally representative and the sample was 62 395 youth deaths (age 15 - 24 years) from the selected NCDs. Cause-specific mortality rates, expressed as percentages, were estimated by age group and sex. Cause-deleted life-table techniques were used to estimate current and projected life expectancy (ex) and life expectancy in the absence of specific NCDs (e-ix).Results. Death rates from NCDs are increasing over time among youth. Total death rates from cancer increased from 1.09% in 1997 2001 to 1.51% in 2012 - 2016. Female death rates from heart disease are almost double those for males. The number of additional years of life gained with elimination of these causes ranges from 2.2 to 10.3. Projected life expectancies show that males could gain as much as 1 additional year and females 1.06 years by 2035.Conclusions. Urgent action needs to be taken to prevent further mortality from non-communicable causes among youth. The results of this study are important to the SA healthcare system and to public health practitioners whose aim is to reduce the strain on public resources and reduce mortality among youth. Future studies should estimate the extent of NCD mortality in households and communities with the aim of developing macro-level interventions.
Husserlian phenomenology was used as the philosophical underpinning for this study, since its purpose is to describe human experience as it is lived by educators who have experienced workplace ...bullying. In-depth interviews were conducted with participants identified by means of the snowball sampling technique. Colaizzi's method for descriptive phenomenology was used to analyse the data. The findings provide insight into the nature of educator-on-educator workplace bullying, the characteristics of the bullying educators and their victims, as well as the consequences of this scourge. Guidelines for the development of an anti-bullying policy for the prevention of workplace bullying are also given.
Freshwater resources are a high-priority issue in the Pacific region. Water shortage is a serious problem in many small island states, and many depend heavily on rainwater as the source of their ...water. lack of safe water supplies is an important factor in diarrheal illness. There have been no previous studies looking specifically at the relationship between climate variability and diarrhea in the Pacific region. We carried out two related studies to explore the potential relationship between climate variability and the incidence of diarrhea in the Pacific Islands. In the first study, we examined the average annual rates of diarrhea in adults, as well as temperature and water availability from 1986 to 1994 for 18 Pacific Island countries. There was a positive association between annual average temperature and the rate of diarrhea reports, and a negative association between water availability and diarrhea rates. In the second study, we examined diarrhea notifications in Fiji in relation to estimates of temperature and rainfall, using Poisson regression analysis of monthly data for 1978-1998. There were positive associations between diarrhea reports and temperature and between diarrhea reports and extremes of rainfall. These results are consistent with previous research and suggest that global climate change is likely to exacerbate diarrheal illness in many Pacific Island countries.
This book scrutinises religion in education in ten countries. It reveals much about the tension between religion and education in secular countries, and the blending between religion and education in ...religious countries, such as Iran and Malaysia, as well as secular countries such as the Netherlands. It also shows the important role the church currently plays in education in developing countries, such as Tanzania.
In order to expand the knowledge base on learner misbehaviour and disciplinary strategies in Lesotho, the present study reports on findings from an inquiry on how school levels, school control and ...school size relate to disciplinary strategies. A cross-sectional survey design was used to collect data from Lesotho teachers. The data were analysed by means of frequencies and the one-way ANOVA test. The frequency tables illustrate that there are some differences in the popularity of 22 disciplinary strategies among the different school levels, types of school control and school sizes concerning the teachers who took part in the study. A comparison of the popularity of the overarching categories (traditional and progressive disciplinary strategies) shows firstly, that primary school respondents use a statistically significantly larger number of progressive strategies than respondents from combined and secondary schools and secondly, that participants from schools with 250-499 learners use statistically significantly more traditional and progressive strategies than their colleagues from smaller and larger schools. The results from the statistical analysis lastly reveal that school control type does not have a statistically significant influence on the preference of both traditional and progressive disciplinary strategies. Although this study was guided by the critical rationalist paradigm, the results are discussed within Lesotho's socio-educational context.
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