Papers by Mosiuoa Z Palime
Access to international and regional markets for beef has been an ongoing problem for southern Af... more Access to international and regional markets for beef has been an ongoing problem for southern African countries for many decades because the South African Territories (SAT) serotypes of foot and mouth disease (FMD) viruses are endemic to wildlife populations in the southern African region. This makes establishment of FMD-free zones, essential for accessing high-value beef markets difficult, expensive and impractical for many locations in southern Africa. For that reason commercialization of livestock production in the region has been inhibited. The creation of FMD-free zones which requires use of artificial or natural boundaries and in southern Africa it has been the construction of veterinary cordon fences (VCFs) to separate animal populations of different FMD status which has proven successful in some countries (such as Botswana, Namibia & South Africa) but not in others for a variety of reasons, i.e. the current 'model' has only been possible for a small proportion of cattle producers in southern Africa. This means that apart from the damaging effects that some VCFs have had or have on the environment generally and wildlife conservation in particular, only roughly 15% of the cattle population in the mainland countries of the Southern African Development Community (SADC) are raised in FMD-free zones. For balanced rural development of the SADC Region, where cattle are culturally and economically vital to the indigenous inhabitants and wildlife conservation and associated economic activities are important contributors to regional gross domestic product, it is essential to improve access to regional and international markets for beef and other animal products produced in locations outside FMD-free zones. The World Organisation for Animal Health (OIE) has introduced a partially non-geographic FMD standard for trade in deboned beef (viz. Terrestrial Animal Health Code Article 8.8.22) that potentially overcomes this problem; however, Article 8.8.22 contains at least one 'killer' requirement that makes its implementation impossible. The issues associated with this problem have been identified in this study and possible solutions proposed. vi An attempt was made to gauge acceptance by SADC Member States but the responses to the questionnaire used were inadequate to reach a reliable conclusion in this respect. It was concluded that taking technical, logistical and financial constraints into account, non-geographic approaches represent the best opportunity that SADC countries have of expanding access to regional and international markets. Moreover, it is suggested that non-geographic approaches could be integrated into the Standard Methods and Procedures in Animal Health (SMP-AH) Programme once adopted by SADC, thereby strengthening the capacity of the Region's competent authorities. SMP-AH Programme is at a proposal stage and has not been officially launched in SADC. The SMP-AH Programme proposes to harmonize activities of animal health authorities of SADC Member States in respect of selected diseases that impact trade and/or human health. vii List of Acronyms ADB African Development Bank ALOP Appropriate level of protection ASF African swine fever x Table of Contents Page Acknowledgements i Dedication ii Declaration iii Abstract v List of Acronyms vii List of figures and tables ix 1. Introduction 1.1. Analysis of the concepts (geographic vs non-geographic approaches) 1.2. Beef production in SADC Region & trade flows 1.3. Need for correction of current beef production and trade trends 1.4. Regional initiatives on beef trade in SADC 2. Hypothesis 3. Objectives 4. Methodology 4.1. Study Area 4.2. Data collection 4.3. Questionnaire design and distribution 4.4. Data Analysis 5. Results 5.1. Socioeconomic and environmental disparities generated by international trade standards that impact on beef trade 5.2 The current regional FMD situation & consequences 5.3 The current international trading system 21 5.3.1 International standards and bodies that set the standards 5.3.2 Equivalence and its possible application in the SADC Region to facilitate improved market access for beef 1.4 New opportunities based on equivalence 23 5.4.1 Articles 8.7.25advantages & disadvantages 23 5.4.2 Compartmentalizationadvantages & disadvantages 27 5.4.3 Value chain systemsadvantages & disadvantages 28 5.4.4 Standard Methods and Procedures in Animal Health Programme 29 6.1 Profile of respondents and Questionnaire results and analysis 31 6. Discussion 7.1 Feasibility of implementing non-geographic approaches 31 a. Conclusion b. Recommendations to SADC Secretariat and OIE 8.1 Adoption of SMP-AH Programme as a SADC regional strategy 34 8.2 Recommended changes to Article 8.8.22 34 c. References d.
Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study
The Lancet HIV, 2021
Background The interaction between COVID-19, non-communicable diseases, and chronic infectious di... more Background The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15–49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19. Methods In this cohort study, we used data submitted to DATCOV, a national active hospital surveillance system for COVID-19 hospital admissions, for patients admitted to hospital with laboratory-confirmed SARS-CoV-2 infection between March 5, 2020, and March 27, 2021. Age, sex, race or ethnicity, and comorbidities (hypertension, diabetes, chronic cardiac disease, chronic pulmonary disease and asthma, chronic renal disease, malignancy in the past 5 years, HIV, and past and current tuberculosis) were considered as risk factors for COVID-19-related in-hospital mortality. COVID-19 in-hospital mortality, the main outcome, was defined as a death related to COVID-19 that occurred during the hospital stay and excluded deaths that occurred because of other causes or after discharge from hospital; therefore, only patients with a known in-hospital outcome (died or discharged alive) were included. Chained equation multiple imputation was used to account for missing data and random-effects multivariable logistic regression models were used to assess the role of HIV status and underlying comorbidities on COVID-19 in-hospital mortality. Findings Among the 219 265 individuals admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and known in-hospital outcome data, 51 037 (23·3%) died. Most commonly observed comorbidities among individuals with available data were hypertension in 61 098 (37·4%) of 163 350, diabetes in 43 885 (27·4%) of 159 932, and HIV in 13 793 (9·1%) of 151 779. Tuberculosis was reported in 5282 (3·6%) of 146 381 individuals. Increasing age was the strongest predictor of COVID-19 in-hospital mortality. Other factors associated were HIV infection (adjusted odds ratio 1·34, 95% CI 1·27–1·43), past tuberculosis (1·26, 1·15–1·38), current tuberculosis (1·42, 1·22–1·64), and both past and current tuberculosis (1·48, 1·32–1·67) compared with never tuberculosis, as well as other described risk factors for COVID-19, such as male sex; non-White race; underlying hypertension, diabetes, chronic cardiac disease, chronic renal disease, and malignancy in the past 5 years; and treatment in the public health sector. After adjusting for other factors, people with HIV not on antiretroviral therapy (ART; adjusted odds ratio 1·45, 95% CI 1·22–1·72) were more likely to die in hospital than were people with HIV on ART. Among people with HIV, the prevalence of other comorbidities was 29·2% compared with 30·8% among HIV-uninfected individuals. Increasing number of comorbidities was associated with increased COVID-19 in-hospital mortality risk in both people with HIV and HIV-uninfected individuals. Interpretation Individuals identified as being at high risk of COVID-19 in-hospital mortality (older individuals and those with chronic comorbidities and people with HIV, particularly those not on ART) would benefit from COVID-19 prevention programmes such as vaccine prioritisation as well as early referral and treatment. Funding South African National Government.
Access to international and regional markets for beef has been an ongoing problem for southern Af... more Access to international and regional markets for beef has been an ongoing problem for southern African countries for many decades because the South African Territories (SAT) serotypes of foot and mouth disease (FMD) viruses are endemic to wildlife populations in the southern African region. This makes establishment of FMD-free zones, essential for accessing high-value beef markets difficult, expensive and impractical for many locations in southern Africa. For that reason commercialization of livestock production in the region has been inhibited. The creation of FMD-free zones which requires use of artificial or natural boundaries and in southern Africa it has been the construction of veterinary cordon fences (VCFs) to separate animal populations of different FMD status which has proven successful in some countries (such as Botswana, Namibia & South Africa) but not in others for a variety of reasons, i.e. the current 'model' has only been possible for a small proportion of cattle producers in southern Africa. This means that apart from the damaging effects that some VCFs have had or have on the environment generally and wildlife conservation in particular, only roughly 15% of the cattle population in the mainland countries of the Southern African Development Community (SADC) are raised in FMD-free zones. For balanced rural development of the SADC Region, where cattle are culturally and economically vital to the indigenous inhabitants and wildlife conservation and associated economic activities are important contributors to regional gross domestic product, it is essential to improve access to regional and international markets for beef and other animal products produced in locations outside FMD-free zones. The World Organisation for Animal Health (OIE) has introduced a partially non-geographic FMD standard for trade in deboned beef (viz. Terrestrial Animal Health Code Article 8.8.22) that potentially overcomes this problem; however, Article 8.8.22 contains at least one 'killer' requirement that makes its implementation impossible. The issues associated with this problem have been identified in this study and possible solutions proposed. vi An attempt was made to gauge acceptance by SADC Member States but the responses to the questionnaire used were inadequate to reach a reliable conclusion in this respect. It was concluded that taking technical, logistical and financial constraints into account, non-geographic approaches represent the best opportunity that SADC countries have of expanding access to regional and international markets. Moreover, it is suggested that non-geographic approaches could be integrated into the Standard Methods and Procedures in Animal Health (SMP-AH) Programme once adopted by SADC, thereby strengthening the capacity of the Region's competent authorities. SMP-AH Programme is at a proposal stage and has not been officially launched in SADC. The SMP-AH Programme proposes to harmonize activities of animal health authorities of SADC Member States in respect of selected diseases that impact trade and/or human health. vii List of Acronyms ADB African Development Bank ALOP Appropriate level of protection ASF African swine fever x Table of Contents Page Acknowledgements i Dedication ii Declaration iii Abstract v List of Acronyms vii List of figures and tables ix 1. Introduction 1.1. Analysis of the concepts (geographic vs non-geographic approaches) 1.2. Beef production in SADC Region & trade flows 1.3. Need for correction of current beef production and trade trends 1.4. Regional initiatives on beef trade in SADC 2. Hypothesis 3. Objectives 4. Methodology 4.1. Study Area 4.2. Data collection 4.3. Questionnaire design and distribution 4.4. Data Analysis 5. Results 5.1. Socioeconomic and environmental disparities generated by international trade standards that impact on beef trade 5.2 The current regional FMD situation & consequences 5.3 The current international trading system 21 5.3.1 International standards and bodies that set the standards 5.3.2 Equivalence and its possible application in the SADC Region to facilitate improved market access for beef 1.4 New opportunities based on equivalence 23 5.4.1 Articles 8.7.25advantages & disadvantages 23 5.4.2 Compartmentalizationadvantages & disadvantages 27 5.4.3 Value chain systemsadvantages & disadvantages 28 5.4.4 Standard Methods and Procedures in Animal Health Programme 29 6.1 Profile of respondents and Questionnaire results and analysis 31 6. Discussion 7.1 Feasibility of implementing non-geographic approaches 31 a. Conclusion b. Recommendations to SADC Secretariat and OIE 8.1 Adoption of SMP-AH Programme as a SADC regional strategy 34 8.2 Recommended changes to Article 8.8.22 34 c. References d.
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Papers by Mosiuoa Z Palime