An unexpected increase in gastroenteritis cases was reported by healthcare workers on the KwaZulu-Natal Coast, South Africa, January 2017 with >600 cases seen over a 3-week period. A case-control study was conducted to identify the source and risk factors associated with the outbreak so as to recommend control and prevention measures. Record review identified cases and controls and structured-telephonic interviews were conducted to obtain exposure history. Stool specimens were collected from 20 cases along with environmental samples and both screened for enteric pathogens. A total of 126 cases and 62 controls were included in the analysis. The odds of developing gastroenteritis were 6.0 times greater among holiday makers than residents (95% confidence interval (CI) 2.0-17.7). Swimming in the lagoon increased the odds of developing gastroenteritis by 3.3 times (95% CI 1.06-10.38). Lagoon water samples tested positive for norovirus (NoV) GI.6, GII.3 and GII.6, astrovirus and rotavirus. Eleven (55%) stool specimens were positive for NoV with eight genotyped as GI.1 (n = 2), GI.5 (n = 3), GI.6 (n = 2), and GI.7 (n = 1). A reported sewage contamination event impacting the lagoon was the likely source with person-to-person spread perpetuating the outbreak. Restriction to swimming in the lagoon was apparently ineffective at preventing the outbreak, possibly due to inadequate enforcement, communication and signage strategies.
Waste-picking is an income-generating opportunity for individuals living in poverty. Waste picking is associated with a range of risk factors for common mental disorders (CMD). This study aimed to determine the prevalence and factors associated with CMD among waste pickers in Johannesburg. A cross-sectional study analyzed secondary data for 365 waste pickers. A validated Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. Multivariable logistic regression was fitted to identify factors associated with CMD. The overall prevalence of CMD among waste pickers was 37.3%. The odds of having CMD were 2.5 and 3.2 higher in females and cigarette smokers, respectively (p = 0.019 and p = 0.003). Life enjoyment (Adjusted odds ratio [aOR] 0.54, p = 0.02) and a good quality of life (aOR 0.34, p ≤ 0.001) were associated with lower odds of CMD. The high prevalence of CMD among waste pickers was significantly associated with cigarette smoking, being female, not enjoying life, and a poor quality of life. Mental health awareness of CMD will assist with the prevention, early detection, and comprehensive management of CMD among waste pickers.
Background South Africa has a high burden of HIV and sexually transmitted infections (STIs). In the absence of viral suppression, STIs may facilitate the onward transmission of HIV to uninfected partners. We determined factors associated with having an unsuppressed VL among HIV-positive patients attending STI services in South Africa.Methods We conducted a cross-sectional analysis of data on HIV-positive patients attending STI services at STI sentinel sites in Western Cape and Gauteng provinces between January–December 2019 in South Africa. We described the HIV-positive patients attending STI services by demographic and clinical factors. A Poisson regression model was used to identify factors associated with having an unsuppressed VL (> 50 copies/ml), considering a p-value cut-off of 0.25 for inclusion in a multivariable model and 95% CI with P < 0.05 statistically significant.Results Among the 93 HIV-positive patients attending STI services with VL data, the median age was 32 years (IQR 27–37 years). Overall, 32 (34.41%) patients were on ART and 61 (65.59%) were not on ART. The majority of patients (90.63%) on ART were aged ≥ 25 years and 65.20% (61) were male. The median HIV VL was 8011 RNA copies/ml (IQR = 78–99171). More than half of the patients on ART had an unsuppressed VL (56.25%) and 86.89% of those not on ART had an unsuppressed VL. After adjusting for age, gender, STI syndrome and ART use; factors associated with having an unsuppressed VL included age < 25 years (adjusted prevalence rate ratio [aPRR] = 1.25, 95% Confidence Interval [95% CI] = 0.99–1.60) and being female (aPRR = 1.12, 95% CI = 0.64–1.97). ART use was associated with a 33% lower prevalence of having an unsuppressed VL (aPRR = 0.67, 95% CI = 0.49–0.92). In a subgroup of those on ART, after adjusting for sex partner number, patients < 25 years old had a higher likelihood of having an unsuppressed VL (aPRR = 1.94: 95% CI = 1.27–2.97) compared to those aged ≥ 25 years old.Conclusion The proportion of HIV-positive patients attending STI services reporting ART use was low and STI service patients had a high prevalence of having an unsuppressed VL regardless of ART status. These results are below the global target of 95%. Intensified ART support interventions targeted at young HIV-positive, females seeking STI services could improve viral suppression outcomes.
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