Urban areas are increasingly being affected by more frequent and severe disasters. It has been argued in theory and international development policy that the integration of disaster risk reduction (DRR) within existing urban planning (UP) curricula would greatly benefit efforts to build resilient urban environments. However, the current status quo and progress of this crucial transdisciplinary integration in the South African University context remain unclear. Through the application of an exploratory mixed method research design, this article established that UP lecturers at South African universities have a good grasp of the theoretical need for the integration of DRR into existing curriculums and have also tentatively started to integrate DRR into some of their modules. However, because of challenges such as full curricula, financial and human resources constraints and integration predominantly happening on postgraduate level, integration has not occurred in sufficient depth while also missing the opportunity to expose the majority of the student cohort and future urban planners to much-needed DRR knowledge. TRANSDISCIPLINARY CONTRIBUTION: This article illuminates the current status of integration across and collaboration between DRR and UP at selected South African Universities.

BACKGROUND: Point-of-care (POC) rapid recency testing can be used as a cost-effective tool to identify recently infected individuals (i.e. infected within the last 12 months) in near-real time, support epidemic control and identify hotspots for transmission as part of recent infection surveillance OBJECTIVE: To evaluate the performance of the Asanté (HIV-1) rapid recency assay as a POC rapid test among blood donors in South Africa (SA METHODS: The study was a cross-sectional and validity study of the Asanté HIV-1 Rapid Recency Assay performed on 715 consecutively archived plasma donor specimens from the SA National Blood Services to determine their recency and established HIV infection status. ELISA and rapid assays for HIV antibody detection were used as the reference-testing standard for confirming an infection, while the Maxim HIV-1 limiting antigen (LAg) avidity assay was used as a reference for comparing HIV recency status. Validity tests (sensitivity, specificity, negative and positive predictive values) and Cohen-Kappa tests of the agreement were conducted to compare the Asanté HIV-1 rapid recency assay results with the reference tests RESULTS: Of the 715 studied blood samples, 63.1% (n=451/715) were confirmed to be HIV-positive based on the reference standard. The sensitivity and specificity of the Asanté HIV-1 rapid recency assay in diagnosing established HIV infection compared to the ELISA were 98.4% (95% CI 96.7 - 99.3) and 99.6% (95% CI 97.6 - 100), respectively. Compared with HIV rapid assay, the sensitivity and specificity of the Asanté HIV-1 rapid recency assay was 98.7% (95% CI 97.0 - 99.4) and 99.2% (95% CI 97.1 - 100), respectively. Of the 451 HIV-positive blood samples, 43% were confirmed as recent HIV infections by the Maxim HIV-1 LAg avidity assay. There was high agreement between the Asanté HIV-1 rapid recency assay and the Maxim HIV-1 LAg avidity assay (94.1%, k=0.879, p<0.0001). The sensitivity and specificity of the Asante HIV-1 assay was 89.4% (95% CI 84.0 - 93.0) and 97.7% (95% CI 94.8 - 99.0), respectively CONCLUSION: The Asanté HIV-1 rapid recency assay test results demonstrated high accuracy (>90%) compared with the HIV ELISA and rapid assays for determining established infection and the Maxim HIV-1 LAg avidity assay for classifying recent HIV-1 infections. The assay's sensitivity for established infections was below the World Health Organization criteria (<99%) for POC devices. The Asanté HIV-1 rapid recency assay can be used to distinguish between recent and long-term infections, but may not be considered a POC test for determining HIV infection

By May 2021, South Africa (SA) had experienced two 'waves' of COVID-19 infections, with an initial peak of infections reached in July 2020, followed by a larger peak of infections in January 2021. Public health decisions rely on accurate and timely disease surveillance and epidemiological analyses, and accessibility of data at all levels of government is critical to inform stakeholders to respond effectively. In this paper, we describe the adaptation, development and operation of epidemiological surveillance and modelling systems in SA in response to the COVID-19 epidemic, including data systems for monitoring laboratory-confirmed COVID-19 cases, hospitalisations, mortality and recoveries at a national and provincial level, and how these systems were used to inform modelling projections and public health decisions. Detailed descriptions on the characteristics and completeness of individual datasets are not provided in this paper. Rapid development of robust data systems was necessary to support the response to the SA COVID-19 epidemic. These systems produced data streams that were used in decision-making at all levels of government. While much progress was made in producing epidemiological data, challenges remain to be overcome to address gaps to better prepare for future waves of COVID-19 and other health emergencies.

BACKGROUND. Better integration of HIV and sexually transmitted infection (STI) prevention and treatment services is needed to accelerate progress towards the goal of zero new HIV infections. OBJECTIVES. To describe HIV positivity, antiretroviral therapy (ART) use, viral suppression and recency of HIV infection among symptomatic STI service attendees at two primary care clinics in South Africa. METHODS. In a cross-sectional study, male and female STI service attendees presenting with symptoms consistent with STI syndromes were enrolled following informed consent. An interviewer-administered questionnaire was completed and appropriate genital and blood specimens were collected for STI testing and HIV biomarker measurements including recency of infection and antiretroviral (ARV) drug levels. Descriptive statistics were used to describe enrolled attendees, and to determine the proportion of attendees who were HIV-positive, recently infected, taking ART and virally suppressed. HIV-positive attendees with detectable ARVs were considered to be on ART, while those with viral loads (VLs) <200 copies/mL were considered virally suppressed. RESULTS. Of 451 symptomatic attendees whose data were analysed, 93 (20.6%) were HIV-positive, with 15/93 (16.1%) being recently infected. Recent infection was independently associated with genital ulcer disease at presentation, especially ulcers with no detectable STI pathogens. Among the 78 (83.9%) with long-term infection, only 30 (38.5%) were on ART, with 23/30 (76.7%) virally suppressed. CONCLUSIONS. In a population at risk of HIV transmission, there was a high burden of recent infection and unsuppressed VLs. Incorporating pre-exposure prophylaxis, ART initiation and adherence support into STI services will be necessary for progress towards eliminating HIV transmission.

SUMMARY OBJECTIVE: To evaluate the effect of the treatment of obstructive sleep apnea syndrome on overactive bladder symptoms. METHODS: All patients who applied to the outpatient clinic with complaints of snoring and apnea were evaluated by polysomnography between years 2017 and 2019. obstructive sleep apnea syndrome severity was evaluated according to the apnea-hypopnea-index. All patients were filled with questionnaire form as overactive bladder symptoms score, international quality of life, international consultation on incontinence questionnaire short-form, and 3-day bladder diary before polysomnography and three months after continuous positive airway pressure therapy and surgical treatment. RESULTS: A total of 125 patients, 34 (27.2%) patients with mild obstructive sleep apnea syndrome, 27 (21.6%) patients with moderate obstructive sleep apnea syndrome, and 64 (51.2) patients with severe obstructive sleep apnea syndrome were included in the study. The prevalence of overactive bladder symptoms in three obstructive sleep apnea syndrome groups were 67.6, 53.8, and 48.4%, respectively, and there was no statistical difference between the groups (p=0.190). obstructive sleep apnea syndrome treatment such as surgical treatment or continuous positive airway pressure therapy was applied to 45.5% (31 patients) patients with obstructive sleep apnea syndrome and overactive bladder. Three months after treatment, the overactive bladder symptoms score significantly decreased from 16.1±7.9–12.80±9.82, international quality of life was significantly increased from 105.0±23.2–110.4±22.2, and incontinence questionnaire short-form decreased from 11.9±4.0–10.4±5.6 (p=0.009, p=0.023, and p=0.248, respectively). There was a significant decrease between before and after treatment in terms of mean day-time frequency and mean urgency episodes of patients (p=0.007, p=0.002). CONCLUSIONS: Both surgery and continuous positive airway pressure treatment of obstructive sleep apnea syndrome improved overactive bladder symptoms, overactive bladder symptoms score, international quality of life, day-time frequency, and urgency episodes.

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OBJECTIF: Mettre au point un modèle permettant d'identifier les zones à haut risque d'épidémies sporadiques de rougeole, sur la base d'une analyse des facteurs associés à une épidémie nationale en Afrique du Sud, entre 2009 et 2011. MÉTHODES: Les données sur les cas survenus avant et pendant l'épidémie nationale ont été obtenues auprès du programme sud-africain de surveillance de la rougeole, et les données sur la vaccination contre la rougeole et la taille de la population auprès du système d'informations sanitaires des districts. Un modèle hiérarchique bayésien de Poisson a été utilisé pour étudier l'association entre le risque de rougeole chez les nourrissons dans un district et la couverture vaccinale pour la première dose, la densité de population, la prévalence sous-jacente de l'infection par le virus de l'immunodéficience humaine (VIH) et l'échec attendu de la séroconversion. Les projections du modèle ont été utilisées pour identifier les nouvelles zones à haut risque en 2012. RÉSULTAT: Un schéma spatial clair des zones à haut risque a été observé, avec de nombreuses zones interconnectées (c'est-à-dire voisines). Un risque accru d'épidémie de rougeole a été significativement associé à la constitution préalable d'une population vulnérable ainsi qu'à la densité de population. Le risque était aussi élevé lorsque plus de 20% des nourrissons dans une zone fortement peuplée n'avaient pas reçu une première dose du vaccin. Le modèle a été en mesure d'identifier les zones à haut risque d'épidémie de rougeole en 2012, ainsi que là où des mesures préventives supplémentaires pourraient être prises. CONCLUSION: L'épidémie de rougeole en Afrique du Sud a été associée à la constitution d'une population vulnérable (en raison d'une couverture vaccinale médiocre), à la prévalence élevée de l'infection par le VIH et à une forte densité de population. Le modèle prédictif développé pourrait être appliqué à d'autres contextes sensibles aux épidémies sporadiques de rougeole et à d'autres maladies qui peuvent être prévenues par la vaccination.

OBJECTIVE: To develop a model for identifying areas at high risk for sporadic measles outbreaks based on an analysis of factors associated with a national outbreak in South Africa between 2009 and 2011. METHODS: Data on cases occurring before and during the national outbreak were obtained from the South African measles surveillance programme, and data on measles immunization and population size, from the District Health Information System. A Bayesian hierarchical Poisson model was used to investigate the association between the risk of measles in infants in a district and first-dose vaccination coverage, population density, background prevalence of human immunodeficiency virus (HIV) infection and expected failure of seroconversion. Model projections were used to identify emerging high-risk areas in 2012. FINDINGS: A clear spatial pattern of high-risk areas was noted, with many interconnected (i.e. neighbouring) areas. An increased risk of measles outbreak was significantly associated with both the preceding build-up of a susceptible population and population density. The risk was also elevated when more than 20% of infants in a populous area had missed a first vaccine dose. The model was able to identify areas at high risk of experiencing a measles outbreak in 2012 and where additional preventive measures could be undertaken. CONCLUSION: The South African measles outbreak was associated with the build-up of a susceptible population (owing to poor vaccine coverage), high prevalence of HIV infection and high population density. The predictive model developed could be applied to other settings susceptible to sporadic outbreaks of measles and other vaccine-preventable diseases.

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OBJETIVO: Desarrollar un modelo para identificar las áreas con riesgo alto de sufrir brotes esporádicos de sarampión en base a un análisis de los factores asociados a un brote nacional en Sudáfrica entre los años 2009 y 2011. MÉTODOS: Los datos de los casos ocurridos antes y durante el brote nacional se obtuvieron del programa de vigilancia del sarampión de Sudáfrica, y la información acerca de la vacunación contra el sarampión y el tamaño de la población, del sistema de información sanitaria por distritos. Se empleó un modelo de Poisson jerárquico bayesiano para investigar la relación entre el riesgo de sarampión en niños de un distrito con la cobertura de la primera dosis de la vacuna, la densidad de población, el historial de prevalencia de la infección por el virus de la inmunodeficiencia humana (VIH) y el fracaso previsto de la seroconversión. Las proyecciones del modelo se utilizaron para identificar áreas de alto riesgo nuevas en 2012. RESULTADOS: Se observó un patrón espacial claro de las áreas de alto riesgo con muchas zonas conectadas (esto es, colindantes). El riesgo superior de sufrir un brote de sarampión se asoció de modo significativo tanto con el crecimiento previo de un grupo de población vulnerable como con la densidad de población, y también fue elevado cuando más del 20% de los niños en un área populosa no había recibido la primera dosis de la vacuna. El modelo fue capaz de identificar las áreas con riesgo alto de sufrir un brote de sarampión en 2012 y donde podrían emprenderse medidas de prevención adicionales. CONCLUSIÓN: El brote de sarampión en Sudáfrica estuvo asociado con el aumento de un grupo de población vulnerable (debido a una cobertura de vacunación insuficiente), una prevalencia elevada de la infección por VIH y una densidad de población alta. El modelo predictivo desarrollado podría aplicarse a otros lugares susceptibles de sufrir brotes esporádicos de sarampión y otras enfermedades inmunoprevenibles.

Humans are holistic beings who engage with natural environments on a cognitive, affective and spiritual level. Research has indicated a clear link between physical and mental health and experiences of nature. When people are alienated from nature due to limited opportunities to visit pristine natural environments, increasing development and the ubiquitous availability of technology, psychological health decreases, whilst emotional and even physical health problems emerge. Little information is available on how human behavioural sciences, such as psychology, and spatial disciplines, such as urban and regional planning, can work together to optimise human-nature interaction - especially in rural nature contexts. A close link exists between people and natural environments. Since most of the research on human-nature interaction focuses on restorative interventions to deal with abnormal behaviour, or on broad trends for large groups of people, it is not clear what the spontaneous experiences of people's interaction with natural environments, comprise. The purpose of this study was to explore spontaneous experiences in natural environments with the aim to discuss implications for spatial development purposes. Two questions were used to guide the research, being: What spontaneous experiences are expressed when people are in natural environments? And: How can gained insights from such experiences be used in the formulation of guidelines for the planning of natural, untainted environments? The research was executed at Kromdraai, an undeveloped farm situated in the Vredefort Dome, South Africa. The Vredefort Dome Area falls within the boundaries of two provinces, the North West and the Free State, and the Vaal River, the largest tributary of the Orange River in South Africa and 1120 kilometres long, runs through the area. The natural landscape includes hills and ridges offering displays of vertical rock layers exposed due to the result of the meteorite crater impact, as well as the Vaal River. Abundant vegetation includes 99 identified plant species, while 450 different bird species and 70 butterfly species have been identified and rare fauna such as the rooikat, aardwolf, leopard, and rock dassie are also found. A qualitative research method was used to obtain the data. An intrinsic case study design was used and 12 participants were requested to share their experiences of their interaction with nature. Participants received cameras and maps and were free to walk the farm. They were asked to photograph anything they came across and regarded as important. Afterwards all participants were requested to participate in a focus group discussion. Participants were requested to share the meaning and the relevance of the photo's they took. Two sets of data were obtained and both the textual and visual data were subsequently analysed thematically. The findings showed that the participants' interactions with pristine natural environments emerged on cognitive, affective and spiritual levels. They expressed experiences such as a sense of escape (cognitive freedom); curiosity, hope and feelings of calmness (affective dimension); as well as feeling closer to God (spiritual experiences) in their interaction with nature. The findings also revealed diverse meanings that people hold regarding their interaction with the natural environment. The relevance that the findings might hold for spatial disciplines, such as urban and regional planning, is an indication of the need to be sensitive to the different relational dimensions that emerge when people interact with natural environments. Development should aim to protect the sensitive nature of the meanings that people attach to the natural environment. In addition, it was found that the seeming discrepancy between personal meanings attached and the views of spatial disciplines can be overcome by negotiation - which should be part of informed public participation. Suggestions are made to explore innovative public participation methods to obtain relevant and useful information about the personal meanings that people attach to natural environments.

Mense beleef kognitiewe, gevoels- en spirituele ervarings wanneer hulle in interaksie met natuurlike omgewings verkeer. Die meeste navorsing oor mense se interaksie met natuurlike omgewings fokus op die gesondheidsvoordele wat dit inhou. Daar is weinig inligting beskikbaar oor navorsing waar die insigte van gedragswetenskaplikes en ruimtelike beplanners gekombineer word om mense se interaksies in natuurlike omgewings te ondersoek ten einde die implikasies vir die ontwikkeling van natuurlike omgewings te bespreek. Die doel van die navorsing was om die spontane reaksies wat mense in 'n natuurlike omgewing ervaar en uitgedruk het, te beskryf en om voorstelle te maak wat deur stads- en streekbeplanners geraadpleeg kan word wanneer riglyne vir ontwikkeling voorgestel word. 'n Intrinsieke gevallestudie is gebruik en 12 deelnemers is deur middel van doelgerigte steekproefneming by die navorsing betrek. Kwalitatiewe navorsing is gebruik en data is deur middel van foto's, fokusgroepgesprekke en indiepte individuele onderhoude ingesamel en tematies ontleed. Die bevindinge dui daarop dat mense kognitiewe, affektiewe en spirituele ervarings in die natuurlike omgewing beleef het. Voorts is ook bevind dat uiteenlopende ervarings oor dieselfde omgewing ervaar is. Die nodigheid hiervan vir stads- en streekbeplanners is dat hulle moet kennis neem van die sensitiewe aard van die verhouding tussen mense en die natuurlike omgewing, aangesien dit belangrike implikasies het vir mense se geestesgesondheid. Verder word voorgestel dat die oënskynlike teenstrydige aard van die persoonlike betekenisse wat mense uit hulle interaksie met die natuurlike omgewing ontwikkel, nie geïgnoreer moet word in die beplanning van ontwikkelings nie, maar eerder deur middel van innoverende prosesse van openbare deelname, verreken moet word.

BACKGROUND: The Tara KLamp (TK) device has been claimed to enable circumcisions to be performed safely and easily in medical and non-medical environments. Published evaluation studies have been conducted among young children only. METHODS: Following a randomised controlled trial (RCT) on 3 274 participants on the impact of male circumcision on HIV transmission, 69 control group members participated in this male circumcision methods trial and were randomised to a forceps-guided (FG) group and a TK group, and circumcised. RESULTS: Of the 166 men asked to participate, 97 declined, most (94) refusing circumcision by the TK technique; 34 men were randomised to the FG group and 35 to the TK group, and 32 and 24 patients were circumcised by the FG and TK methods respectively, of whom 29 and 19 respectively attended the post-circumcision visit. All 12 adverse event sheets corresponded to the TK group (p<0.001) and circumcisions by the TK method. Less favourable outcomes were associated with the TK method, including any sign of an adverse event (37% v. 3%; p=0.004), delayed wound healing (21% v. 3%; p=0.004) and problems with penis appearance (31% v. 3%; p=0.001). Participants randomised to the TK method were significantly more likely to report bleeding (21% v. 0%; p=0.02), injury to the penis (21% v. 0%; p=0.02), infection (32% v. 0%; p=0.002), swelling (83% v. 0%; p<0.001), and problems with urinating (16% v. 0%; p=0.056). The mean score of self-estimated pain was 9.5 for participants circumcised by TK compared with 6.1 for other participants (adjusted p=0.003). Conclusion. This study provides compelling evidence that strongly cautions against use of the TK method on young adults.