Universal HIV testing and treatment and HIV stigma reduction: a comparative thematic analysis of qualitative data from the HPTN 071 (PopART) trial in South Africa and Zambia

Despite continued development of effective HIV treatment, expanded access to care and advances in prevention modalities, HIV‐related stigma persists. We examine how, in the context of a universal HIV‐testing and treatment trial in South Africa and Zambia, increased availability of HIV services influenced conceptualisations of HIV. Using qualitative data, we explore people’s stigma‐related experiences of living in ‘intervention’ and ‘control’ study communities. We conducted exploratory data analysis from a qualitative cohort of 150 households in 13 study communities, collected between 2016 and 2018. We found that increased availability of HIV‐testing services influenced conceptualisations of HIV as normative (non‐exceptional) and the visibility of people living with HIV (PLHIV) in household and community spaces impacted opportunities for stigma. There was a shift in community narratives towards individual responsibility to take up (assumingly) widely available service – for PLHIV to take care of their own health and to prevent onward transmission. Based on empirical data, we show that, despite a growing acceptance of HIV‐related testing services, anticipated stigma persists through the mechanism of shifting responsibilisation. To mitigate the responsibilisation of PLHIV, heath implementers need to adapt anti‐stigma messaging and especially focus on anticipated stigma.     

Delivering a psychosocial program for older people living in retirement homes during the Covid-19 pandemic: A process evaluation and recommendations for community interventions

The Covid-19 pandemic lockdown regulations caused retirement homes to temporarily ban in-person visitation potentially increasing the mental health risks of older people. An opportunity arose for a multistakeholder community collaboration to design a mental health program for older people. To evaluate the process of delivering a 12-week psychosocial program aimed at preventing loneliness, countering boredom, and providing older people in restricted settings with education about Covid-19 during the lockdown, in Durban, South Africa. A qualitative retrospective design was used. Data from two focus groups and six semistructured individual interviews conducted with stakeholders (volunteers, social workers, and residents) postproject were analyzed using reflexive thematic analysis. Stakeholders had varied experiences of the project, in terms of content, processes of engagement, and implementation, resulting in five themes. The study concluded with recommendations. A strong need exists for multistakeholder community collaborations when implementing a program where the context restricts physical access.     

Chrysotile asbestos and health in Zimbabwe: I. Analysis of miners and millers compensated for asbestos-related diseases since independence (1980)

Data on the health effects caused by locally mined chrysotile asbestos in Zimbabwe have been very limited. The prevailing local view has been that risk is minimal. In this report we critically reassess the cases of 51 individuals with asbestos exposure who have been compensated by the Central Pneumoconiosis Bureau since independence in 1980. Results demonstrate that the major health risks of exposure reported elsewhere--morbid asbestosis, nonmalignant pleural disease, malignant mesothelioma, and lung cancer--all occur in Zimbabwe, at least among workers in the asbestos mines and mills. It is concluded that further investigation and control measures in the industry are warranted.     

Epidemiology of Injuries at a Tertiary Care Center in Malawi

Background  Injury surveillance is an ongoing process required for primary, secondary, and tertiary injury prevention. In Malawi, hospital-based injury data are not available. Methods  From February to June 2008 we collected data on injured patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi. The sample (n = 1,474) was predominantly male (75.7%), and age distribution was bimodal (peak age groups <5 years and 26–30 years). Road-traffic injury (RTI) was the most common reason for treatment (43.4%), followed by assault (24.0%), which was more common than expected. The most common injuries were lacerations, contusions, and abrasions. We observed both gender- and age-specific patterns in injury mechanism: Injured females were more likely than injured males to have suffered an injury as a passenger in a car or on a bicycle, or to have suffered from falls, foreign bodies, and burns; injured males were more likely than injured females to have suffered an injury as an automobile driver or bicyclist, or from an assault. Falls, burns, and foreign bodies affected younger victims, whereas bicyclists, automobile drivers, and motorcycle operators were generally older persons. Results  The hospital admission rate was 26.8%. Most patients arrived by private vehicle (43.8%), which was also the fastest means of transportation. There were 25 mass casualties leading to 102 admissions; all but one were due to RTIs, and seven were associated with at least one fatality. Conclusions  This study elucidated injury epidemiology in Malawi and identified questions for future research. Other developing countries should conduct such prospective data collection to identify region-specific injury patterns and to promote injury prevention.     

Chrysotile asbestos and health in Zimbabwe: II. Health status survey of active miners and millers.

As part of the effort to establish industrial practice and public policy regarding asbestos in Zimbabwe, we have conducted a cross-sectional study of the chrysotile mines and mills. A stratified random sample of workers with greater than 10 years of exposure has been evaluated by spirometry, chest radiographs, and employment history. The latter was converted to quantitative estimates of exposure dose, using a matrix based on measured and reconstructed fiber levels for each job and facility during the years of work. Based on these data, a clear dose-response between asbestos exposure and functional loss has been demonstrated, with mean losses from predicted of about 400-600 cc in vital capacity in the 10% of the population with heaviest exposures. Low-grade parenchymal radiographic abnormalities (ILO grade greater than or equal to 1/0) were evident in 8.7% of the total study group and were almost 10 times more common in those with more than 100 fibers/cc.years cumulative exposure than in those with 16 fibers/cc.years or less. Pleural disease was relatively rare, occurring in just under 10% of the study group, and was unrelated to exposure dose. Overall, these findings are compatible with results of similar studies in Quebec and Swaziland and suggest that similar control strategies are probably indicated.     

Noma (Cancrum Oris): A Report of a Case in a Young AIDS Patient with a Review of the Pathogenesis

Noma (cancrum oris) is a mutilating necrotising disease of the orofacial tissues. It affects predominantly debilitated malnourished children, in whom the necrotic process may cause severe damage to mid-facial structures. Its aetiopathogenesis is uncertain, but its course is fulminating, and without timely intervention the disease may be fatal. Antibiotic treatment during any stage of necrotising stomatitis and of its sequel noma can stop progression of the disease; therefore detection and treatment of early intraoral necrotising lesions whether necrotising gingivitis, necrotising periodontitis or necrotising stomatitis are critical in preventing noma. We present an extreme case of noma in a malnourished HIV-seropositive child. There was an acute necrotic process affecting both the maxilla and the mandible with denudation of bone, spontaneous exfoliation of teeth, necrotising fasciitis and myonecrosis which destroyed the lips and cheeks and extended to the infra-orbital margins. There was severe disfigurement and severe impairment of function. Noma is primarily an anaerobic bacterial infection with secondary ischaemia leading to osteonecrosis and mid-facial destruction.     

Synthesis and characterization of an efficient and stable Al/Fe pillared clay catalyst for the catalytic wet air oxidation of phenol

A facile method for synthesizing Al/Fe pillared clays (PILCs) from natural bentonite clay, by using ultrasonic treatment during the aging and intercalation steps, has been established. Single metal (Fe-PILCs and Al-PILCs) and mixed metal (Al/Fe-PILCs, with varying compositions of the pillaring precursors) pillared clays were prepared and characterized with a combination of chemical and instrumental methods. The pillared clays were evaluated as catalysts in the catalytic wet air oxidation (CWAO) of phenol and the mixed metal pillared clay catalysts, especially with an Al/Fe ratio of 3 : 1, were found to be highly active and stable, with superior properties such as surface areas, basal spacing, high porosity and thermal stability. The catalysts could also be reused several times without significant loss of activity. The results of the study show that Al/Fe-pillared clay catalysts are effective catalysts for the oxidation of phenol and removal of TOC in aqueous solutions. The main intermediate products in the CWAO of phenol were hydroquinone, pyrocatechol, and benzoquinone and oxalic, formic, malonic, oxalic, malonic and maleic acids.

A facile method for synthesizing Al/Fe pillared clays (PILCs) from natural bentonite clay, by using ultrasonic treatment during the aging and intercalation steps, has been established.     

Prevalence of pneumonoconiosis among coal and heavy metal miners in Zimbabwe

No prevalence data on pneumonoconiosis among Zimbabwe's 30,000 miners have been available. Passage of a 1984 law requiring examination of all miners has provided a data base to assess this, but the records had not been previously evaluated or stored in a manner to facilitate this. In 1988 we developed a strategy to utilize the existing records to estimate cross-sectional rates rapidly. In this report, we describe the approach and demonstrate high rates of simple pneumonoconiosis among long-term workers in the coal, nickel, copper, and gold mines. These data, though limited, provide a rationale for more detailed investigations in these workforces and an impetus to establish an ongoing surveillance plan for the nation's miners.     

Synthesis and application of pillared clay heterogeneous catalysts for wastewater treatment: a review

The use of pillared interlayered clays (PILCs) as heterogenous catalysts in wastewater treatment technologies, particularly advanced oxidation processes (AOPs), is gaining popularity for the treatment of refractory wastewater effluents. The recent literature involving these solid materials is reviewed, with more focus on studies that aim at reducing the synthesis costs and escalating the synthesis process to industrial scale. Their role as active solid materials in the AOPs such as photocatalysis, catalytic wet peroxide oxidation (CWPO), the Fenton process and catalytic wet air oxidation (CWAO) of refractory organic compounds in polluted aqueous streams is also reviewed. These processes are evaluated to evidence their main direction for future research, particularly with reference to possible industrial use of these technologies to treat refractory organic wastewater using pillared clay-based catalysts. The pillared clay catalysts demonstrate good application prospects for the removal of refractory wastewater effluents using AOP technology. The reviewed studies suggest that the photocatalytic process is useful in low concentrations of these compounds, while CWPO, the Fenton process and CWAO are recommended for higher concentrations. However, catalyst development to reduce the severity of oxidation reaction conditions, with focus on the low cost, catalyst stability, reusability and environmental friendliness are the key aspects to be addressed by future research work.

The use of pillared interlayered clays (PILCs) as heterogenous catalysts in wastewater treatment technologies, particularly advanced oxidation processes (AOPs), is gaining popularity for the treatment of refractory wastewater effluents.