Poovendhree Reddy

In South Africa, approximately 4.5 million confirmed COVID-19 cases and 103,000 deaths have been noted. Symptoms range from being asymptomatic, mild respiratory issues to severe multi-organ failure and consequent death. Cardiometabolic risk factors, viz., type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), atherosclerosis, chronic kidney disease, hypertension, heart failure, and obesity, are flagged as the most prevalent comorbidities associated with the risk of severe COVID-19 and death. Many who have recovered from hospitalization continue to experience lingering symptoms known as long COVID, which have been linked to new-onset cardiometabolic disorders (CMD). This narrative review thus focusses on the clinical factors and the patient burden of diabetes mellitus and hypertension as two of the most commonly observed CMD, and aims to raise awareness regarding possible cardiometabolic complications. The findings expand the existing literature on the cardiometabolic effects of COVID-19, concentrating on outcomes observed more than three months after the acute phase of the illness.

Tuberculosis (TB) remains a major public health challenge in sub-Saharan Africa, driven by high transmission, delayed diagnosis, and limited surveillance. This study presents one of the first integrated applications of shotgun metagenomic and metatranscriptomic sequencing to investigate Mycobacterium communities in wastewater across six TB-endemic countries: Cameroon, Ghana, Kenya, Nigeria, South Africa, and Uganda. Twelve untreated and treated wastewater samples were analysed to characterise taxonomic composition, strain-level diversity, and transcriptional activity. Metagenomic analyses revealed diverse Mycobacterium communities, including M. tuberculosis, M. canettii, M. bovis, and members of the M. avium complex. Metatranscriptomic data detected MTBC-associated transcripts, indicating transcriptional activity and/or persistence of MTBC RNA signals in wastewater, with higher signal predominance in influent samples, consistent with community-level shedding. Metagenome-assembled genomes (MAGs) recovered from South Africa, Cameroon, and Uganda showed >82% completeness and included zoonotic species. MTBC strains clustered into Lineages 1, 2, 4, and 6, with animal-adapted strains linked to livestock and rodents, highlighting One Health relevance. Overall, this dual-omics approach supports wastewater-based epidemiology as a scalable tool for TB surveillance in high-burden settings.

Long COVID‐19 (LC) syndrome is a complex systemic illness that is currently recognised to have a high morbidity rate and hospitalisations. The study analysed factors linked to LC in adults self‐isolated during COVID‐19 infection in KwaZulu‐Natal Province, South Africa, focusing on two densely populated districts (uMgungundlovu and eThekwini Metro Municipality). We employed a cross‐sectional study among individuals aged 18 years and above who self‐isolated at home. Demographic data, COVID‐19 vaccination status, and post‐COVID‐19 health symptoms were collected using a standardised questionnaire. The National Health and Nutrition Survey’s Physical Functioning Questionnaire was adapted to evaluate health and functional outcomes six months after a COVID‐19 diagnosis, addressing both physical and psychosocial symptoms during that timeframe. A modified Poisson regression model was used to determine the predictors of LC and hospitalisation. Of the 280 participants, 46% ( n = 130) reported having at least one health‐related symptom, while 36% ( n = 47) had ≥ five symptoms. Approximately half of the participants (50%, n = 139) had at least one hospital admission following infection due to persistent symptoms. Older age (aIRR 1.5; 95% CI: 1.2–3.2; p = 0.021), reinfection (aIRR 2.0; 95% CI: 1.3–3.0; p = 0.001), having positive household contacts (aIRR 2.1; 95% CI: 1.4–3.2; p < 0.001) and hospitalisation (aIRR 7.7; 95% CI: 3.8–15.6; p < 0.001) increased the risk of developing LC. Post‐infection hospitalisation was significantly associated with symptoms such as anxiety (aIRR 1.4; 95% CI: 1.1–1.7; p = 0.009), depression (aIRR 1.9; 95% CI: 1.6–2.3; p < 0.001), sore throat (aIRR 1.5; 95% CI: 1.7–2.0; p = 0.002) and weight loss (aIRR 1.8; 95% CI: 1.4–2.4; p < 0.001). A considerable percentage of participants with post‐SARS‐CoV‐2 infections presented with long‐term complications and required medical intervention. Postpandemic healthcare planning and resource allocation need to be considered since increased morbidities associated with LC place a burden on the already inadequately funded healthcare system.

Background: HIV/AIDS continues to be of concern, particularly in South Africa, where the current prevalence is 12.7%. Objectives: This study aimed to explore sexual practices that increased HIV vulnerability among clinic users who chose to initiate pre-exposure prophylaxis (PrEP) in KwaZulu-Natal, South Africa. Method: A quantitative approach was utilised to collect data at an urban clinic in eThekwini (n = 376). Data were analysed using SPSS v29. Results: Participants were predominantly female (n = 331; 88%), single (n = 343; 91.5%), and heterosexual (n = 368; 98.1%). Sexual debut occurred at 18.4 ± 2.58 years. More men reported having concurrent sexual partners (n = 24; 54.5%). Transactional sex was more often reported by single women aged 18 years to 24 years. Age-disparate relationships were more common among those aged 18 years to 24 years. A significant association between early sexual debut and the number of lifetime partners was identified (P < 0.001). Conclusion: Our findings indicate that the study population was aware of their increased HIV vulnerability and were willing to try preventive measures, such as PrEP, to protect against seroconversion. However, interventions are required to abate the cycle of transactional sex, age-disparate relationships, and early sexual debut, especially among young women aged 15 years to 24 years.

Objective: This study aimed to investigate risk factors associated with risky sexual behaviors (RSBs) and HIV seropositivity among students from four universities in KwaZulu‐Natal, South Africa. Design: A case‐control methodology was used. Sample: The sample consisted of 500 students (375 HIV negative students and 125 students living with HIV). Measurement: Adjusted logistic regression modeling was performed to assess the association of predictors with RSBs and HIV seropositivity. Results: Data showed that heavy episodic drinking [aOR: 2.73, (95% CI: 1.38; 5.44), p = 0.004], drugs before sex [aOR: 7.46, (95% CI: 2.11; 27.88), p = 0.003], and a higher number of lifetime sex partners increased students’ likelihood of having multiple concurrent sex partners (2–5 lifetime partners) [aOR: 4.22, (95% CI: 1.69; 10.54), p = 0.002] and ≥ 6 lifetime partners [aOR: 16.36, (95% CI: 6.18; 43.28), p < 0.001]. Conclusion: These findings indicate a need for South African universities to offer HIV prevention programs that inform students of how participation in particular risky activities can result in engagement in specific RSBs, contributing to a heightened HIV infection risk. Re‐evaluation and strengthening of these prevention programs can ensure optimal efficiency in the battle against HIV infection.

Background: The National School Nutrition Programme (NSNP) provides meals to schools in low-income areas in South Africa, implemented by the Department of Basic Education (DBE) with food safety monitored by Municipal Health Services. Aim: To assess compliance of school kitchens with general hygiene requirements (R638 of 2018) and detect food pathogens on food contact surfaces using amplified metagenomics. Setting: The study was conducted in quintile 1 and 2 primary schools in Vryheid, KwaZulu-Natal. Methods: A quantitative cross-sectional study assessed the safety compliance of food preparation and storage areas in 33 primary schools against national legislation standards. Fifteen samples of food contact surfaces were collected from four schools and analysed using Illumina sequencing to identify prevalent bacterial genera. Results: None of the schools possessed a Certificate of Acceptability. Significant structural issues include poor pest control, inadequate sanitary facilities, a lack of food safety training and inadequate waste management. Taxonomic analysis revealed several dominant bacterial genera, including Pseudomonas, Stenotrophomonas, Acinetobacter and Pantoea, indicating potential routes for food contamination and subsequent risks for foodborne illnesses. Conclusion: The study highlighted critical inadequacies in food preparation and storage areas requiring urgent intervention to ensure safe meal preparation. It emphasised the need for improved food safety monitoring and compliance in schools in low-income areas. Next-generation sequencing (NGS) techniques identified a broad spectrum of pathogens, offering a robust method for assessing environmental hygiene. Contribution: This study provides insights into food safety risks in the NSNP, informing policies and interventions to improve food safety and reduce foodborne illnesses in schools.

Virulence attributes and putative antibiotic resistance genes from enterococcal isolates from wastewater treatment facilities for sustainable reuse and the areas where they discharge treated water were assessed using phenotypic and molecular methods. This analysis was performed on 269 Enterococci, of which 202 were vancomycin-resistant Enterococcus (VRE). VRE strains show markedly higher resistance across multiple antibiotics, especially glycopeptides and beta-lactams, compared to the more susceptible profile observed in vancomycin-susceptible Enterococcus (VSE) strains. vanC was found in every instance of E. gallinarum among VRE and enterococci susceptible to vancomycin (VSE) isolates but not in VR E. faecium/faecalis. Among VRE, 127 (62.9%) possessed at least one of the tetK, tetL, tetM, or tetO, while 22 (17.3%) had two of these genes. The multidrug efflux pump gene emeA was detected in 27 out of 202 (13.4%) VRE isolates and 8 out of 67 (11.9%) VSE isolates. Exactly 69 (78.4%) possessed at least one of the virulence determinants tested, with 10 (11.4%) and seven (8%) positive for haemolysis and gelatinase activity respectively. The gelatinase gene, gelE, was detected in 16 (18.1%) isolates, while more isolates (n = 23; 26.1%) were positive for gelatinase activity. Cytolytic (cyl) genes (1.1%), Angiotensin-converting-enzyme genes (ace) (13.6%), endocarditis-specific antigen A genes (efaA) (25%), hyaluronidase (hyl) genes (9.1%), enterococcal surface protein (esp) genes (4.5%), among others, were detected. Gelatinase activity and the amplified virulence genes were further validated by sequencing the gel-positive amplicons, which were almost identical (98.97%), and the gelE gene of Enterococcus sp. strain SQ07C was deposited under the GenBank accession number PQ381122. Overall, our results showed that the enterococcal isolates were considered as potential pathogens of notable threat to human health via exposure through reuse, and there is a need for more stringent treatment protocols.