eThekwini Municipality

The delivery of energy and water meter data, management and control information on separate networks is expensive and defeats the gains of the Advanced Metering Infrastructure (AMI) Smart Grid (SG). In most cases, energy, gas and water services are offered by the same organizational entity, hence the use of different infrastructure for data, service delivery, control and management is expensive and highly illogical. There is a need for a combined energy and water infrastructure to reap the benefits of the AMI SG. Furthermore, combined metering will result in accurate billing, potential cost savings, and improved resource management. This work therefore develops and investigates a combined energy and water AMI smart metering framework. This is possible through a thorough understanding of the AMI technological standards. The implementation of such a system is not trivial, as it depends on many factors: environmental, geographical, technological, economical, regulatory and the existing legacy infrastructure. Optimal technological implementation choices are developed towards an integrated AMI infrastructure. An experimental test bed is developed for delivering energy and water metering data to the utility. The optimal placement results favor the system of separating energy and water actuators at the home area network of the SG while using an integrated communication system. Such a system is feasible, given the different evolution of electricity and water meters and their placement at the home area network, and enables water metering to benefit from the more advanced electrical metering infrastructure.

Background. Despite reduction of the global maternal mortality ratio by 38% between 2000 and 2017, morbidities during the postpartum period remain the leading cause of maternal death in developing countries. In Africa, most maternal deaths occur during the postpartum period, and deaths during this period are common in South Africa (SA). Objectives. To estimate the incidence of postpartum morbidities and associated risk factors among women attending a community health centre in SA. Methods. A facility-based cross-sectional study was undertaken. Both continuous and categorical variables were described using descriptive statistics. Factors associated with postpartum conditions were determined by logistic regression with adjusted odds ratios (ORs), 95% confidence intervals (CIs) and p-values. Statistical significance was set at p<0.05. Results. A total of 399 postpartum women participated, with a mean age of 26.1 years. The teenage pregnancy rate was 19.3%, the majority fell into the age group 20 - 34 years (66.5%) and were single (70.1%), and 68.4% had no income. Only 30.2% of mothers had planned the index pregnancy. All of them knew their HIV status, and 41.7% were HIV infected. The postpartum morbidity rate was 35.9%. Logistic regression analysis showed that women who had normal vaginal deliveries (NVDs) and were in full-time employment had lower ORs for any postpartum morbidity (OR 0.47; 95% CI 0.26 - 0.86; p=0.014 and OR 0.44; 95% CI 0.21 - 0.88; p=0.022, respectively). Participants with no education had an OR of 3.1 (95% CI 1.21 - 8.15; p=0.019). Conclusion. The high postpartum morbidity rate is comparable to previously reported findings at midwife obstetric units in SA. Women who had no education were at increased risk of postpartum conditions, while full-time employment and NVD had protective effects. Skilled obstetric care and maintenance of strict asepsis during delivery are necessary to prevent common postpartum morbidities. Postnatal care should be improved to address the main risks to mothers, and socioeconomic challenges need to be addressed.

Abstract Three Interlinked Electronic Register (TIER.Net) is South Africa’s national electronic HIV patient database, used to monitor antiretroviral therapy (ART) delivery and laboratory results. However, few published evaluations have quantified TIER.Net data quality relative to national sources. We aimed to evaluate how well decentralised ART referral and laboratory result data are captured in TIER.Net. We conducted a retrospective analysis comparing TIER.Net to national electronic health systems. For decentralised ART, we used de-identified data from 56 clinics in eThekwini (2020-2023) and compared the annual number of TIER.Net decentralised ART referrals to ART prescriptions in the Synchronised National Communication in Health (SyNCH) database. For laboratory data, we used de-identified records from 103 clinics in KwaZulu-Natal (2015-2022) and compared the annual number of TIER.Net viral load (VL) and CD4 tests with the number in National Health Laboratory Service (NHLS). The proportion of SyNCH decentralised ART prescriptions and NHLS VL and CD4 counts captured in TIER.Net were calculated by clinic, and trends were assessed using linear mixed-effects models (LMMs). The median proportion of SyNCH decentralised ART prescriptions captured in TIER.Net was 104.4% (IQR: 99.85-115.1 % ) in 2020 and 102.44% (IQR: 100.5-104.5%) in 2023. The LMM estimated an annual decrease of 2.8% (95% CI: -4.8; -0.9%). The median proportion of NHLS VLs captured in TIER.Net was 85.7% (IQR: 70.0-97.9%) in 2015 and 99.1% (IQR: 94.5-102.5%) in 2022. The LMM estimated an annual increase of 1.8% (95% CI: 1.4-2.1%). The median proportion of NHLS CD4s captured in TIER.Net was 74.3% (IQR: 63.9-85.4%) in 2015 and 80.1% (IQR: 68.4-89.1%) in 2022. The LMM estimated no statistically significant trend over time (-0.08%, 95% CI: -0.6; 0.4%). Reassuringly, capture of TIER.Net for decentralised ART and VL data has improved to near 100%, but CD4 count capture remains sub-optimal, highlighting strengths and limitations of conducting analyses with this critical HIV programme database.

Abstract Advanced HIV disease (AHD), treatment interruption and viraemia remain key challenges to effectiveness of HIV programmes in South Africa. Understanding the trends of these measures and their variation across geographic regions can inform more targeted and responsive interventions. We conducted a retrospective cohort study using routine, de-identified data from TIER.Net, a national HIV electronic register. We curated data from 116 primary care clinics in eThekwini, uMgungudlovu, and uMkhanyakude Districts in KwaZulu-Natal province. We included people living with HIV aged ≥16 years, who initiated or collected ART between 1 July 2018 and 30 June 2023. We examined trends in annual proportion of AHD, treatment interruption and viraemia, and mapped the clinic-level proportions of these outcomes using inverse distance weighted interpolation maps. Among 123,473 clients initiating ART with CD4 count measurements, the overall prevalence of AHD remained stable over the period (20.0%-22.2%). There was an overall decline in treatment interruptions from 13.2% to 11.3% among the 544,066 clients who had scheduled visits. Of the 446,899 clients who had viral load results, overall viraemia ≥50 copies/mL increased from 12.9% to 20.2%, whereas viraemia ≥1000 copies/mL remained stable at approximately 6%. Spatial analyses highlighted geographic disparities in AHD, treatment interruption, and viraemia across and within the districts. While declines in treatment interruptions are promising, the persistence of AHD and viraemia (≥50 copies/mL) require further investigation and highlight ongoing challenges for HIV control. The observed spatial variation across districts underscores the need of geographically tailored interventions to strengthen programmatic effectiveness, particularly in hyper-endemic settings like KwaZulu-Natal.

Manor & KwaDabeka CHC) TROA data for January

Although the demand for energy appears to increase perpetually, the methods by which energy is generated are changing. The sole dependance on utilities and municipalities for power is over and customers can generate and utilize their own power. Furthermore, they can store excess power and mechanisms are in place to sell excess power to the grid. Electricity still is the most efficient and widely used form of energy globally. Due to global warming and climate change, the methods of generation are moving away from fossil fuels towards more sustainable and thus renewable options. Many cities have thus taken it upon themselves to align to global targets of reducing their greenhouse gas (GHG) emissions. Coupled with the decreasing cost of renewable energy, the relaxation of regulations, and the current generation constraints, cities are considering generation from Independent Power Producers (IPPs). The power grid is evolving at the generation, transmission, and at the utility level. This is a trend amongst large cities globally and is now being seen within South Africa. Insights into the potential for renewables within SA, the current planning and forecasting methodologies are analyzed. The introduction of renewables into the grid has necessitated the grid to evolve, which is a trend that will continue given the current disruption within the energy sector.

Conserving and restoring biodiversity is central to the achievement of the Sustainable Development Goals. The need to curb biodiversity loss through the mainstreaming of biodiversity considerations within land-use planning is consistently highlighted in global biodiversity assessments intended for policymakers and practitioners. We present a Global South local government-led examination of the mainstreaming of biodiversity issues within a biodiversity hotspot area. Here, we evaluated the four-decade-long evolution in open space planning in Durban, South Africa, in response to shifting urbanisation, governance and policy/legislative contexts. We assessed the role of science in responding to contextual changes, the need for champions, and key institutional interventions undertaken to embed a biodiversity function within local government. In addition, we investigated how biodiversity concerns have been incorporated into land-use planning applications via the city’s environmental planning function. We provide evidence of the advancement of mainstreaming biodiversity concerns within local government processes, institutional functions, and land-use decision-making. This has been achieved through effective and sustained leadership; the use of science and scientific information in advancing the policy and legislative environment and building political support by responding to shifting governance contexts; investment in institutional scientific capacity and generating scale-appropriate biodiversity information. Learnings from this paper may be useful for other local governments addressing biodiversity loss through land-use planning processes, by identifying critical investment areas that may shorten the time required for effective mainstreaming.