scholarly journals Implementing novel regimens for drug-resistant TB in South Africa: what can the world learn?

2020 ◽  
Vol 24 (10) ◽  
pp. 1073-1080
Author(s):  
N. Ndjeka ◽  
J. Hughes ◽  
A. Reuter ◽  
F. Conradie ◽  
M. Enwerem ◽  
...  
Keyword(s):  
South Africa ◽  
South African ◽  
Recent Change ◽  
New Drugs ◽  
Diagnostic Tools ◽  
Who Guidelines ◽  
Policy Changes ◽  
Close Collaboration ◽  
Resistant Tuberculosis ◽  
Global Leader

Worldwide uptake of new drugs in the treatment of rifampicin-resistant tuberculosis (RR-TB) has been extremely low. In June 2018, ahead of the release of the updated WHO guidelines for the management of RR-TB, South Africa announced that bedaquiline (BDQ) would be provided to virtually all RR-TB patients on shorter or longer regimens. South Africa has been the global leader in accessing BDQ for patients with RR-TB, who now represent 60% of the global BDQ cohort. The use of BDQ within a shorter modified regimen has generated the programmatic data underpinning the most recent change in WHO guidelines endorsing a shorter, injectable-free regimen. Progressive policies on access to new drugs have resulted in improved favourable outcomes and a reduction in mortality among RR-TB patients in South Africa. This supported global policy change. The strategies underpinning these bold actions include close collaboration between the South African National TB Programme and partners, introduction of new TB diagnostic tools in closely monitored conditions and the use of locally generated programmatic evidence to inform country policy changes. In this paper, we summarise a decade´s work that led to the bold decision to use a modified, short, injectable-free regimen with BDQ and linezolid under carefully monitored programmatic conditions.

scholarly journals Population Pharmacokinetics and Pharmacodynamics of Ofloxacin in South African Patients with Multidrug-Resistant Tuberculosis

2012 ◽  
Vol 56 (7) ◽  
pp. 3857-3863 ◽  
Author(s):  
Emmanuel Chigutsa ◽  
Sandra Meredith ◽  
Lubbe Wiesner ◽  
Nesri Padayatchi ◽  
Joe Harding ◽  
...  
Keyword(s):  
South Africa ◽  
Population Pharmacokinetics ◽  
South African ◽  
Multidrug Resistant ◽  
Pharmacokinetic Data ◽  
Target Attainment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Study Population ◽  
African Patients

ABSTRACTDespite the important role of fluoroquinolones and the predominant use of ofloxacin for treating multidrug-resistant tuberculosis in South Africa, there are limited data on ofloxacin pharmacokinetics in patients with multidrug-resistant tuberculosis, no ofloxacin pharmacokinetic data from South African patients, and no direct assessment of the relationship between ofloxacin pharmacokinetics and the MIC of ofloxacin of patient isolates. Our objectives are to describe ofloxacin pharmacokinetics in South African patients being treated for multidrug-resistant tuberculosis and assess the adequacy of ofloxacin drug exposure with respect to the probability of pharmacodynamic target attainment (area under the time curve/MIC ratio of at least 100). Sixty-five patients with multidrug-resistant tuberculosis were recruited from 2 hospitals in South Africa. We determined the ofloxacin MICs for theMycobacterium tuberculosisisolates from baseline sputum specimens. Patients received daily doses of 800 mg ofloxacin, in addition to other antitubercular drugs. Patients underwent pharmacokinetic sampling at steady state. NONMEM was used for data analysis. The population pharmacokinetics of ofloxacin in this study has been adequately described. The probability of target attainment expectation in the study population was 0.45. Doubling the dose to 1,600 mg could increase this to only 0.77. The currently recommended ofloxacin dose appeared inadequate for the majority of this study population. Studies to assess the tolerability of higher doses are warranted. Alternatively, ofloxacin should be replaced with more potent fluoroquinolones.

scholarly journals Significant Factors Influencing Quality Assurance Practices in Small and Medium-Sized Construction Projects in South Africa

2019 ◽  
Vol 11 (2(J)) ◽  
pp. 30-44
Author(s):  
Kgashane Stephen Nyakala ◽  
Thinandavha Thomas Munyai ◽  
Jan-Harm Pretorius ◽  
Andre Vermeulen
Keyword(s):  
South Africa ◽  
Quality Assurance ◽  
South African ◽  
Financial Management ◽  
Construction Projects ◽  
Project Planning ◽  
Diagnostic Tools ◽  
Research Approach ◽  
Road Building ◽  
Factors Influencing

Although implementing quality assurance (QA) processes in construction play an important role in the South African economy has been acknowledged. However, constructions SMEs are faced with difficulties in improving rural road infrastructure and high-quality roads. Additionally, past research has failed to reach consensus on the construction process and socioeconomic settings in previously disadvantaged areas in South Africa, including the factors influencing negatively the performance of such factors. This research examines what factors facilitate or inhibit the success of construction SMEs and what actions can be taken to being distressed construction SMEs under control. The study adopted a quantitative research approach in which a three-section questionnaire was administered to 160 purposively chosen road- building experts in a South African construction SMEs. The questionnaire was structured into three parts, which sought the participants’ profile, identified the quality assurance practices (QAPs) incorporated in the construction SMEs’ road building programmes, and identified the factors that negatively influence the implementation of QA processes. Data was analysed using the Statistical Package for the Social Sciences (SPSS) version 22. Furthermore, to determine the reliability of the various constructs, mean scores, descriptive statistics and standard deviations were obtained. The empirical findings established eight QAPs that were reliable and valid for implementation processes that can control or minimise their causes of poor quality in projects undertaken by construction SMEs, level of skill acquisition; project planning and control techniques; project construction design; process implementation and process improvement; financial management; organisational structures; involvement of people; and quality standards and measurements. The eight factors attained high Cronbach Alpha values above the recommended 0.70 which indicates high internal consistencies among the sub-scales. Findings from this study should be useful to managers in similar environments may use the results of this study as either diagnostic tools or as a reference benchmark for strategic interventions in solving construction projects related problems. Furthermore, the researchers also recommend that these practices are for quality assurance in construction projects undertaken by SMEs in South Africa.

scholarly journals Modelling average maximum daily temperature using r largest order statistics: An application to South African data

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Murendeni M. Nemukula ◽  
Caston Sigauke
Keyword(s):  
South Africa ◽  
Order Statistics ◽  
South African ◽  
Heat Waves ◽  
Value Theory ◽  
Extreme Value ◽  
Daily Temperature ◽  
Diagnostic Tools ◽  
Maximum Daily Temperature ◽  
Average Maximum

Natural hazards (events that may cause actual disasters) are established in the literature as major causes of various massive and destructive problems worldwide. The occurrences of earthquakes, floods and heat waves affect millions of people through several impacts. These include cases of hospitalisation, loss of lives and economic challenges. The focus of this study was on the risk reduction of the disasters that occur because of extremely high temperatures and heat waves. Modelling average maximum daily temperature (AMDT) guards against the disaster risk and may also help countries towards preparing for extreme heat. This study discusses the use of the r largest order statistics approach of extreme value theory towards modelling AMDT over the period of 11 years, that is, 2000–2010. A generalised extreme value distribution for r largest order statistics is fitted to the annual maxima. This is performed in an effort to study the behaviour of the r largest order statistics. The method of maximum likelihood is used in estimating the target parameters and the frequency of occurrences of the hottest days is assessed. The study presents a case study of South Africa in which the data for the non-winter season (September–April of each year) are used. The meteorological data used are the AMDT that are collected by the South African Weather Service and provided by Eskom. The estimation of the shape parameter reveals evidence of a Weibull class as an appropriate distribution for modelling AMDT in South Africa. The extreme quantiles for specified return periods are estimated using the quantile function and the best model is chosen through the use of the deviance statistic with the support of the graphical diagnostic tools. The Entropy Difference Test (EDT) is used as a specification test for diagnosing the fit of the models to the data.

scholarly journals Review of Diagnostic Tests for Detection of Mycobacterium bovis Infection in South African Wildlife

2021 ◽  
Vol 8 ◽  
Author(s):  
Netanya Bernitz ◽  
Tanya J. Kerr ◽  
Wynand J. Goosen ◽  
Josephine Chileshe ◽  
Roxanne L. Higgitt ◽  
...  
Keyword(s):  
South Africa ◽  
South African ◽  
Mycobacterium Bovis ◽  
Bovine Tuberculosis ◽  
Diagnostic Tests ◽  
Clinical Disease ◽  
Diagnostic Tools ◽  
Wildlife Species ◽  
Conservation Concern ◽  
And Control

Wildlife tuberculosis is a major economic and conservation concern globally. Bovine tuberculosis (bTB), caused by Mycobacterium bovis (M. bovis), is the most common form of wildlife tuberculosis. In South Africa, to date, M. bovis infection has been detected in 24 mammalian wildlife species. The identification of M. bovis infection in wildlife species is essential to limit the spread and to control the disease in these populations, sympatric wildlife species and neighboring livestock. The detection of M. bovis-infected individuals is challenging as only severely diseased animals show clinical disease manifestations and diagnostic tools to identify infection are limited. The emergence of novel reagents and technologies to identify M. bovis infection in wildlife species are instrumental in improving the diagnosis and control of bTB. This review provides an update on the diagnostic tools to detect M. bovis infection in South African wildlife but may be a useful guide for other wildlife species.

scholarly journals What’s left of ‘the left’ in post-apartheid South Africa?

2016 ◽  
Vol 41 (2) ◽  
pp. 291-313 ◽  
Author(s):  
Stephen R Hurt
Keyword(s):  
South Africa ◽  
South African ◽  
The Self ◽  
Current Development ◽  
Growth Path ◽  
Policy Changes ◽  
The South ◽  
Broad Agreement ◽  
The Masses ◽  
Meaningful Sense

This article addresses the question of ‘the left’ in contemporary South Africa in two senses: first, in terms of assessing the health of leftist politics; second, it asks to what extent are the self-identified left progressive in any meaningful sense. The first half of this article reflects on the current development situation in South Africa. Here, it is argued that within most sections of the South African left, there is broad agreement on the need to address the triple challenge of unemployment, rising inequality and poverty. The second half of this article identifies three broad sections to the contemporary left in South Africa (the Tripartite Alliance, the left outside the Alliance and the remnants of the revolutionary socialist left). It argues that the left within the Alliance, despite the launch of the New Growth Path, are failing to implement the sufficiently radical policy changes that are required to address the development challenges identified in the first half of this article. The left outside the Alliance, meanwhile, despite recent attempts at coordination, lacks influence and remains disconnected from the masses.

scholarly journals ‘Segregation has fallen on evil days’: Smuts' South Africa, global war, and transnational politics, 1939–46

2012 ◽  
Vol 7 (3) ◽  
pp. 438-460 ◽  
Author(s):  
Jonathan Hyslop
Keyword(s):  
South Africa ◽  
United Nations ◽  
South African ◽  
African State ◽  
World Politics ◽  
Transnational Politics ◽  
Policy Changes ◽  
Colonial Policy ◽  
British Colonial ◽  
Global War

AbstractSouth African state policy in the 1940s moved in significantly new political directions that were not simply the prelude to apartheid. This shift, under the leadership of Jan Smuts, towards a welfarist management of black urbanization, can only be understood by focusing on transnational dimensions of the period that have been neglected by historians of South Africa. The reorganization of the state was made possible as a consequence of the business of fighting a global war. South African policy changes were intimately linked to the evolution of British colonial policy. And the South African interventions in world politics to support the creation of the United Nations and to reconfigure the southern African subcontinent were to have drastic and unforeseen consequences.

scholarly journals Health Risk Assessment of PM2.5 and PM2.5-Bound Trace Elements in Thohoyandou, South Africa

2021 ◽  
Vol 18 (3) ◽  
pp. 1359
Author(s):  
Karl Kilbo Edlund ◽  
Felicia Killman ◽  
Peter Molnár ◽  
Johan Boman ◽  
Leo Stockfelt ◽  
...  
Keyword(s):  
South Africa ◽  
Risk Assessment ◽  
Air Pollution ◽  
Health Risk ◽  
South African ◽  
Health Risks ◽  
Quality Standards ◽  
Ambient Air ◽  
Who Guidelines ◽  
Us Epa

We assessed the health risks of fine particulate matter (PM2.5) ambient air pollution and its trace elemental components in a rural South African community. Air pollution is the largest environmental cause of disease and disproportionately affects low- and middle-income countries. PM2.5 samples were previously collected, April 2017 to April 2018, and PM2.5 mass determined. The filters were analyzed for chemical composition. The United States Environmental Protection Agency’s (US EPA) health risk assessment method was applied. Reference doses were calculated from the World Health Organization (WHO) guidelines, South African National Ambient Air Quality Standards (NAAQS), and US EPA reference concentrations. Despite relatively moderate levels of PM2.5 the health risks were substantial, especially for infants and children. The average annual PM2.5 concentration was 11 µg/m3, which is above WHO guidelines, but below South African NAAQS. Adults were exposed to health risks from PM2.5 during May to October, whereas infants and children were exposed to risk throughout the year. Particle-bound nickel posed both non-cancer and cancer risks. We conclude that PM2.5 poses health risks in Thohoyandou, despite levels being compliant with yearly South African NAAQS. The results indicate that air quality standards need to be tightened and PM2.5 levels lowered in South Africa.

Reframing Xenophobia in South Africa as Colour-Blind: The Limits of the Afro Phobia Thesis

2020 ◽  
Vol 17 (3) ◽  
pp. 433-444
Author(s):  
Amanuel Isak Tewolde
Keyword(s):  
South Africa ◽  
South African ◽  
Analytical Framework ◽  
Conflict Theory ◽  
Black African ◽  
South Africans ◽  
Theoretical Perspectives ◽  
Online Newspaper ◽  
Close Proximity ◽  
Realistic Conflict Theory

Many scholars and South African politicians characterize the widespread anti-foreigner sentiment and violence in South Africa as dislike against migrants and refugees of African origin which they named ‘Afro-phobia’. Drawing on online newspaper reports and academic sources, this paper rejects the Afro-phobia thesis and argues that other non-African migrants such as Asians (Pakistanis, Indians, Bangladeshis and Chinese) are also on the receiving end of xenophobia in post-apartheid South Africa. I contend that any ‘outsider’ (White, Asian or Black African) who lives and trades in South African townships and informal settlements is scapegoated and attacked. I term this phenomenon ‘colour-blind xenophobia’. By proposing this analytical framework and integrating two theoretical perspectives — proximity-based ‘Realistic Conflict Theory (RCT)’ and Neocosmos’ exclusivist citizenship model — I contend that xenophobia in South Africa targets those who are in close proximity to disadvantaged Black South Africans and who are deemed outsiders (e.g., Asian, African even White residents and traders) and reject arguments that describe xenophobia in South Africa as targeting Black African refugees and migrants.

Region of Birth and Child Mortality among Black Migrants to South Africa: Is there a foreign-born advantage?

2016 ◽  
Vol 13 (3) ◽  
pp. 359-376 ◽  
Author(s):  
Tiffany L Green ◽  
Amos C Peters
Keyword(s):  
South Africa ◽  
South African ◽  
Child Mortality ◽  
Southern Africa ◽  
Strong Relationship ◽  
Developed Countries ◽  
Black Immigrants ◽  
Foreign Born ◽  
Region Of Origin ◽  
Child Deaths

Much of the existing evidence for the healthy immigrant advantage comes from developed countries. We investigate whether an immigrant health advantage exists in South Africa, an important emerging economy.  Using the 2001 South African Census, this study examines differences in child mortality between native-born South African and immigrant blacks.  We find that accounting for region of origin is critical: immigrants from southern Africa are more likely to experience higher lifetime child mortality compared to the native-born population.  Further, immigrants from outside of southern Africa are less likely than both groups to experience child deaths.  Finally, in contrast to patterns observed in developed countries, we detect a strong relationship between schooling and child mortality among black immigrants.

Some Reflections on Reparation in Post-Apartheid South Africa, using a Couple Therapy Intervention as a Microcosm of South African Society

2011 ◽  
Vol 1 (2) ◽  
Author(s):  
Andrea Hill ◽  
Sylvia Poss
Keyword(s):  
South Africa ◽  
South African ◽  
Couple Therapy ◽  
South African Society ◽  
Depressive Position ◽  
Central Hypothesis ◽  
Transference And Countertransference ◽  
Constructive Engagement ◽  
The Impact ◽  
Therapy Intervention

The paper addresses the question of reparation in post-apartheid South Africa. The central hypothesis of the paper is that in South Africa current traumas or losses, such as the 2008 xenophobic attacks, may activate a ‘shared unconscious phantasy’ of irreparable damage inflicted by apartheid on the collective psyche of the South African nation which could block constructive engagement and healing. A brief couple therapy intervention by a white therapist with a black couple is used as a ‘microcosm’ to explore this question. The impact of an extreme current loss, when earlier losses have been sustained, is explored. Additionally, the impact of racial difference on the transference and countertransference between the therapist and the couple is explored to illustrate factors complicating the productive grieving and working through of the depressive position towards reparation.

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