Microbes all compete for the same limited nutrients, space, and resources; therefore, they show competitive relationships. There is a component of Alcaligenes faecalis that inhibits the growth of Staphylococcus aureus, a gram-positive bacterium that causes many clinical diseases. We are interested in finding what genetic factors in Alcaligenes faecalis are responsible for killing Staphylococcus aureus. Transposon mutagenesis was used to interrupt certain gene segments by introducing a foreign piece of DNA into the Alcaligenes faecalis genome. By creating mutants of Alcaligenes faecalis, we were able to test these against Staphylococcus aureus to find those that can no longer inhibit. The absence of zones of inhibition indicated that we successfully interrupted the genetic element in Alcaligenes faecalis that kills Staphylococcus aureus. The genome of the mutants that presented no zones of inhibition were isolated to perform RACE PCR. After completing RACE PCR, the mutants were visualized using gel electrophoresis, and they were sequenced. In the sequence, we discovered that the gene that was being interrupted was MFS Transporter. This is an important transporter in bacteria for virulence, metabolism, and quorum sensing. Results from this study may help us find new targets for Staphylococcus aureus infections.

As humans continue to advance healthcare resources, we face a growing threat of nosocomial multidrug-resistant bacteria. The rise of these antibiotic-resistant microorganisms has been placed on the World Health Organization’s watchlist as one of the biggest threats to global health. We continue to have a shortage of effective antibiotics with the rise of these “superbugs”. With the growing number of deadly pathogens, the future of medicine relies on scientific findings to combat multidrug-resistant bacteria. Appalachia could be the answer to combat this new health threat. As the most biodiverse temperate forest region in North America, our beautiful backyard in the Smoky Mountains contains a plethora of microorganisms that have become genetically diversified over billions of years. Many of these soil bacteria naturally produce their own antibiotics. With the wide variation of natural bacteria, Appalachia serves as a testing ground to harness the power of natural antibiotics. A gram of soil contains more than 10,000 different species of bacteria. The biodiversity of these microbes is still largely unknown, as almost 99% of these species cannot be cultured in a normal lab setting. This pilot project will lay the foundations of discovering Appalachia’s microbiota which has, thus far, never been cataloged.

BACKGROUND: In wealthier countries, sudden infant death syndrome (SIDS) is consistently mentioned as a leading preventable cause of infant mortality. However, in Africa, little is known about SIDS. The general view in the Global Health community is that SIDS is not a significant cause of infant mortality in low resource settings. But is this assumption correct? It seems illogical that SIDS would only be confined to high-income settings. An alternative hypothesis is that we are in a situation where SIDS in Africa has historically not been a priority area for research. Consequently, we may have fallen into the common trap where the absence of evidence is misconstrued as evidence of absence. The focus of this thesis is to challenge these assumptions. METHODS: We do this in stages. First, we present results of a systematic review of published studies about SIDS in Africa. Second, we analyze a recently collected unique data set consisting of verbal autopsy data from the next of kin of several hundred deceased infants to attempt to quantify the burden of apparent SIDS deaths. Third, we assess the burden of canonical risk factors for SIDS using prospectively collected survey data. And fourth, we analyze individual attitudes, knowledge, and experience with SIDS collected via focus groups and in-depth interviews to better understand awareness of SIDS and its risk factors, and the potential that these could be modified. RESULTS: The systematic review confirmed that SIDS is poorly studied in Africa. Most of the research on SIDS in Africa comes from South Africa. The incidence of SIDS was high, with reported incidence rates of between 3.01 to 3.70 per 1000 live births in South Africa compared to 0.3 per 1000 live births in the U.S. Bedsharing and prone/lateral sleeping were universally prevalent in countries where these were assessed. In Zambia, 7.4% of decedent infants who died at home died suddenly and unexpectedly, with 5.4% presumably dying of SIDS. In surveys, nearly all infants (89.5%) shared a bed with an adult during sleep, and nearly two-thirds slept (73%) in the lateral position. Infants rarely slept in the recommended supine/back position. In focus group discussions, mothers indicated that they felt the supine sleep position posed an aspiration risk to the infant. Most cited health care workers and experienced women in the community as sources of information on sleep practices. CONCLUSION: Contrary to the prevailing view of SIDS in low to middle-income countries, in Africa and Zambia specifically, SIDS may be a significant cause of infant mortality, but it is going unrecognized or unreported. Public health interventions in Africa and Zambia are overlooking SIDS as an important cause of infant mortality. Interventions to prevent SIDS, such as laying the infant to sleep on the back, are low cost and will be worthwhile in reducing the high infant mortality rates in these settings.

BACKGROUND: Limited qualitative research examining community factors have been performed in Ethiopia to investigate vulnerabilities in orphans and vulnerable children and negative health and educational outcomes. To address this gap, a comprehensive mixed methods parent evaluation was conducted. For the present study, we will make use of the evaluation’s rich source of qualitative data to examine the vulnerabilities for orphans and vulnerable children (OVCs) in Ethiopia using a socio-ecological approach exploring qualitative views of caregivers, community members, and children, at the individual, household, interpersonal and community levels. METHODS: In-depth interviews (IDIs) with adult caregivers, focus group discussions (FGDs) with adult community members, and community mappings (CMs) or focus group discussions with children were conducted in four regions of Ethiopia (Amhara, Tigray, Oromia and SNNPR) as one component of the parent evaluation. Questions addressed known vulnerabilities of OVCs. A subset and majority of the above qualitative data (46 IDIs, 26 CMs and 19 FGDs) were analyzed for this present study. Data were analyzed using a thematic socio-ecological approach. RESULTS: A total of 377 participants (224 children and 153 adults) were included in the study sample. Amhara was the most represented out of the four regions with 50% of the adult FGDs and 43% of the child CMs occurring there. FGDs were representative of both genders, while IDIs of caregivers were conducted with predominantly female respondents (78.3%). Individual Level Vulnerabilities: Both child and adult respondents identified the health of children as a fundamental issue affecting all aspects of quality of life. The main issues that participants discussed relating to child health were poor nutrition (51/86, 59.3%), lack of adequate clothing (44/86, 51.2%), poor shelter (40/86, 46.5%), poor physical health (33/86, 38.4%), poor mental health (20/86, 23.3%), and poor hygiene (19/86, 22.1%). In general, respondents were very aware of the wide-ranging issues that girls in Ethiopian society face making them more vulnerable to abuse. For example, respondents noted families often pressured girls into early or forced marriages (7/86, 8.1%), wealthy families employed girls as maids or nannies, forcing girls to live away from their families (10/86, 11.6%), and families discouraged girls from attending school (4/86, 4.6%). Child respondents spoke more frequently and vocally about these issues than adult respondents. Children frequently and urgently described work-related risks, such as physical and sexual harm, caused by work-related exposure to certain harmful environments. Respondents talked at length about work-related exposures in 29% (25/86) of all transcripts; participants highlighted children working for subsistence was often at the cost of school attendance. Household Level Vulnerabilities: Respondents generally identified caregiver’s age, mental and physical health, and relation to child as vulnerabilities at the household level. Respondents highlighted in comments that households with more elderly caregivers, for example, grandparents or retired parents, are less able physically and financially to support the child. Non-parent households and HIV-affected households were also more vulnerable to negative health and educational outcomes. Respondents strongly emphasized poor shelter as a vulnerability across all FGDs, CMs and IDIs (40/86, 46.5%). Respondents mentioned poor shelter only second in frequency to poor nutrition (51/86, 59.3) and lack of adequate clothing (51.2%, 44/86). Participants identified the quality of housing as crucial to children learning successfully. Respondents frequently described home ownership as a vulnerability since renting and rising rent create future uncertainties in caregivers’ ability to provide shelter and other necessities to children. Most feared by respondents was the inability to pay rent and being forced to live out on the street. Worries within the community expressed by respondents were centered around the safety of homeless children. Interpersonal Level Vulnerabilities: Respondents identified the following basic needs that were not met by caregivers: provision of food and nutrition, shelter, adequate clothing and material goods for hygiene. Almost all respondents identified the main cause of these inadequacies in caregiving as poverty. Participants highlighted a range of abuses, including sexual, physical and emotional abuse both within and outside of the home. Child respondents in CMs most frequently discussed forced labor (20/26, 76.9%), sexual abuse (13/26, 50%), and physical abuse (10/26, 38.5%). In general, discussion of abuse was more prominent in child than adult focus groups. Children in CMs (20/26, 76.9%) were many times more likely to discuss issues of forced labor in comparison to adult respondents in FGDs (1/14, 7.1%) and IDIs (2/46, 4.4%); child respondents in half (13/26) of the CMs discussed sexual abuse in contrast to adult respondents in two out of 14 (14.3%) FGDs and only one out of 46 (2.2%) IDIs. There was no major difference between regions in how frequently abuse was discussed. The most common abusers and abuse location were parents at home. Community Level Vulnerabilities: Respondents described numerous community-level vulnerabilities, including: lack of safe spaces, educational system infrastructure challenges, lack of job opportunities for child and caregiver, weak health care infrastructure and inability to meet many basic needs of community. Respondents recognized the effects of community level vulnerabilities on child vulnerabilities at all other levels. CONCLUSIONS: This study contributes to the literature on needs of vulnerable youth in Ethiopia. Collecting children’s perspectives and narratives on their environment and needs provides direct insight to services and programs that are designed for OVCs. Understanding what children within communities most fear but face daily helps target these services. OVCs are not heterogenous. Within the broader category of OVCs, certain subsets of OVCs, such as AIDS-orphaned children, street children and female OVCs, are more vulnerable to abuse, worse mental health outcomes and lower educational achievement than others, which justifies the targeting of services at children in these particularly vulnerable groups. Our findings are concerning regarding the prevalence of child abuse and gender-related abuses, such as early child marriage, which need to be addressed in future interventions. The socioecological approach provides a helpful perspective on community level vulnerabilities affecting children’s abilities to navigate the world individually and interpersonally. The interactivity of vulnerabilities between socioecological hierarchies, at the individual, household, interpersonal, and community/society levels, within broad interwoven themes of education, health, shelter, security, gender, and caregiving, make the results from this study particularly useful. Additional research in this area will be crucial to helping understand policy design and interventions that protect the most vulnerable of children. / 2024-02-09T00:00:00Z

Drunk driving is a public health threat, endangering the lives of all road users. Younger drivers are inclined to engage in risk-taking behaviour, such as drunk driving with BAC levels exceeding the legal limit. The prevalence of drunk driving in the country has increased among the youth, with children starting to drink alcohol under the age of 13 year in the country. In the Western Cape province, alcohol consumption and risk-taking behaviour were prevalent among school-going children. Younger drivers (15 to 19 years) had the highest driver mortality rates per registered driver, compared to older drivers in the province. Graduated driver license (GDL) programmes provide a supervised learning opportunity for younger drivers to gain driving skills and include a zero-alcohol tolerance restriction. The usefulness of implementing a GDL programme in the country needs to be explored. It is therefore important to understand the impact of alcohol-related risk-taking behaviour among younger drivers. This retrospective cross-sectional study measured alcohol-attributable crash risk by age and sex, from a sample of 921 driver fatalities from Western Cape mortuary records (2009 to 2011). Poisson regression was used to ascertain whether the mortality risk profile for young drivers was differentially affected by alcohol. Female drivers aged 15 to 24 years with zero or low BAC levels (<0.05 g/100ml) were the reference category. Statistical significance was set at p< 0.05. The median age for all driver deaths in the sample was 37 years (IQR 27-49), with 820 males representing 89% of the sample. BAC levels tested among 351 driver fatalities represented 38.1% of the study sample. The median BAC level among all tested driver deaths was zero, with more than half of the sample having BAC levels less than 0.05 g/100ml. The median age for 150 driver deaths with BAC levels ≥ 0.05 g/100ml, was 32.5 years (IQR 26–42). Among 140 male driver deaths testing positive for alcohol, the median BAC level was 0.18 (IQR 0.13- 0.23) and among ten female drivers 0.2 g/100ml (0.11-0.21). Male drivers were five times more likely to die from a fatal alcohol-related crash (IRR 5.02; p< 0.001; 95% CI: 3.86-6.53). The relative mortality rate was highest among drivers aged 25 to 34 years (IRR 1.54; 95%CI 1.43-1.66; p< 0.001). The findings from this study highlights the need for continued and improved BAC surveillance and indicates the need for the broader application of alcohol interventions and development of a GDL programme.

Community participation is now widely recognized as an integral part of health systems and the right to health. Health Committees are an example of participation, influenced by multiple social factors, yet little research has covered the impact of gendered power relations in health committees themselves. Committees are also deemed to be accountability structures, aiming to bolster the efforts of an overburdened health system and aid in responding to the need for often under-resourced services relating to women's and sexual orientation and gender identity (SOGI) minorities' health and sexual reproductive health rights. Current literature affirms the social mobilisation of communities via participation structures, with all committee members needing to be empowered in their roles to provide a greater reach and platform for marginalised groups as both committee and community members. A qualitative, exploratory study was undertaken to answer the question: What is the role of gendered power relations in Health Committees in the Western Cape? Multiple methods were used during March to December 2015 that included observation of Health Committee meetings, group discussions and indepth interviews. A Gender-based Analysis using African Feminist Theory was applied, with Connell's 1987 theory of gender and power as well as considerations of community participation as a function of citizenship. Findings showed that the perception of gender equality and gender relations amongst Health Committees remains largely misunderstood and unaddressed. The Draft Western Cape Health Boards and Facilities Bill of 2015 provided an unstable political backdrop during fieldwork. Democratic group processes did not nullify manipulation of gender roles, and a disconnection between leadership positions and influential agents could be seen. This was accompanied by no notable gender bias concerning health need foci and a non-discriminatory outlook towards committee participants or service recipients, however there was no action to engender such claims, such as special training or materials to support sexual and gender minorities. Adequate representation and reinforcing accountability of Health Committees remains a challenge. Gender mainstreaming in inclusive policy needs to be operationalised at facility level, and gendersensitivity training for Health Committees is a viable approach with which to address the continuing poor policy to implementation problem. The Western Cape Health Boards and Facilities Act of 2016 shows some promise towards recognising and broadening committee governance and diversity. Women and SOGI minorities must be supported in leadership roles to strengthen scaling up efforts and enable the Health Committees to function as truly accountable and participatory instruments for public health.

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Background: Exclusive breastfeeding (EBF) is the international gold standard for infant feeding in the first 4-6 months of life. In sub-Saharan Africa, breastfeeding has been adversely affected by the HIV epidemic, due to breastmilk-associated mother-to-child transmission (MTCT) risk in the absence of triple antiretroviral therapy (ART). However, with rapidly expanding global accessibility of ART, HIV treatment and infant feeding guidelines now recommend universal ART for all women ("Option B+") with breastfeeding as the optimal infant feeding choice in most settings. Data is scarce on breastfeeding practices in this context. This project seeks to describe early infant feeding practices among HIV-infected women initiating ART in an Option B+ PMTCT clinic in peri-urban Cape Town, South Africa. Methods: The Maternal-and-Child-Health-Antiretroviral (MCH-ART) study (2013-2016) enrolled HIV-infected women initiating ART in pregnancy; breastfeeding mother-infant pairs were followed until 18 months. Data were collected via interviews at scheduled study visits, including repeated measures of infant feeding practices (24-hour recall). EBF duration was defined from delivery date to date of last visit reporting EBF. A priori-defined maternal-infant characteristics potentially associated with early EBF cessation (< 4 months/never) were evaluated using exploratory data analysis and multivariable logistic regression. Results: Of 471 breastfeeding mother-infant pairs, 429 (91%) were ever EBF. Median duration of EBF was 1.5 months (interquartile range, IQR 0.3-5.4); only 115/471 (24%) were EBF for 4 months or longer. Median maternal age was 28 years (IQR 24-32); 41% were married/co-habiting; 58% delivered at primary care level. Women who reported any lactation concerns by 6 weeks postpartum (22%) were more likely to cease EBF prematurely (adjusted odds ratio, aOR 1.77; 95% CI 0.96-3.27). Adjusting for alcohol use, poverty, gravidity, delivery mode, maternal age and education, other factors associated with early EBF cessation included relationship status (married/co-habiting vs. single, aOR 0.50, 95%CI 0.31-0.81), place of delivery (secondary vs. primary, aOR 1.94, 95%CI 1.06-3.54), and antenatal maternal anxiety (aOR 4.02, 95%CI 0.91-17.72). Conclusions: Exclusive breastfeeding is sub-optimal in this setting. Lactation problems are common, and strongly associated with premature EBF cessation. Additional lactation support is urgently required in PMTCT settings promoting breastfeeding. Trial registration: ClinicalTrials.gov NCT01933477