UNIVERSITY OFZULULAND

RESEARCH CAPACITY DEVELOPMENT INITIATIVEFor selected South African Universities

UNIVERSITY OFZULULAND

Institution: University of Fort Hare

PI: DR MANDISA SINGATA

The COHERE Project: Contraceptive Options for Health: Evidence, Research and Education

Effective contraceptive use has the potential

to reduce maternal and perinatal mortality. We intend to use robust research methods including randomised controlled trials (RCT) and systematic reviews to guide contraceptive services and to inform contraception users. This will include: An auxiliary study nested in a large RCT

of depot medroxyprogesterone acetate (DMPA) versus the Norethisterone implant versus the copper intrauterine device (IUD) to measure relative effects on depression, sexual function and other effects.

A follow-up of our recent RCT comparing DMPA with the IUD to determine rates of and reasons for discontinuation; and

Updating our Cochrane reviews on these methods of contraception.

Institution: University of Fort Hare

PI: PROF EUNICE SEEKOE

Mentoring and promoting healthy lifestyles of learners in the Eastern Cape: An evaluation of the 2012 Integrated School Health Policy

The 2012 Integrated School Health Policy (ISHP) was introduced in South Africa to contribute to the improvement of general health of school going children as well as the environmental conditions in schools. ISHP addresses health barriers to learning and promotes education

outcomes (DoH & DBE, 2012). Childrens health in the Eastern Cape Province (ECP) is beset with myriads of challenges. There is a general public outcry of poor public health services due to insufficient staff, lack of or insufficient basic equipment, negative attitude of nurses and poor infrastructure. The need for the evaluation of the 2012 ISHP remains an essential element for decision making in social and health policy development in the Eastern Cape Province.

Our main general objective is to assess whether the provision of a comprehensive, integrated school health programme which is provided as part of the PHC package within the Care and Support for Teaching and Learning (CSTL) framework is implemented; identify challenges and success of the package; initiate and/or recommend best practices/intervention strategies support initiation of relevant interventions based on baseline results as well as conducting a fully-fledged evaluation of the implementations by 2018. Assess the implementation of the health care services for primary and secondary school learners as proposed in the Integrated School Health Policy (ISHP) and the role of ward-based primary health team (WBOT), principals, life-orientation educators. Explore the perceptions of the learners, mothers/guardians, school management structures and policy makers concerning the integrated school health services. Determine the barriers and enablers associated with the effective implementation of the 2012 ISHP including health and nutritional status of learners. Determine the mentoring needs of the different stakeholders and draft a framework for optimizing the implementation of the ISHP in the EC Province.

A mixture of quantitative and qualitative descriptive design will be followed in this study. The focus will be on primary and secondary (Grade R to Grade 12) including learners with special needs attending public schools including stakeholders of the school community in OR Tambo; Chris Hani, and Buffalo City Metropolitan districts in the

traditional food plants as part of their diet. Indigenous plant foods have the potential for commercialization to contribute to food security, alleviate poverty and add nutritional value for a healthy community. One of the aims of this project is to document the diversity and utilization patterns of plant foods in rural areas around the former Transkei, Eastern Cape. Information on the value of these plants to younger generations may increase utilisation thus contributing to healthy diet and food security. Acceptability studies of vegetables will be conducted in high school and university students to identify plants for cultivation. Additionally, biological effects of selected food plants will be conducted to confirm the potential of these plants in contributing towards health. This project will thus, highlight the value of underutilised food plants of the Eastern Cape with evidence from animal and human studies while establishing a relationship between rural communities and the Faculty of Health Sciences at WSU.

Institution: University of Zululand

PI: DR ABIDEMI PAUL KAPPO

Development of capacity in phytotherapeutics derived from indigenous plants of South Africa, aimed at improving or preventing the

development of metabolic disease.

The incidence of chronic diseases such as obesity, type 2 diabetes (T2D) and cardiovascular diseases are on the increase globally. The prevalence of these diseases, especially in rural South Africa is increasing at an alarming rate. Hence, a demand exists for natural products that are safe and effective in the treatment of these chronic diseases. Studies have shown polyphenols as beneficial phytochemicals, which are present in plant extracts and can serve as attractive alternatives or adjuncts to conventional medications in the treatment of these chronic diseases.

The focus of this study is the identification, isolation and characterization of bioactive components of nutraceutical products or drug leads from indigenous South African plants such as Atricia phylicoides (Bush tea or Zulu tea) and Protorhus longifolia for health needs. This study is funded by the SAMRCs Research Strengthening and Capacity Development Initiative. Under this initiative, the University of Zululand (UZ) will receive R1 000 000 per annum for the next five years. The major aim of this initiative is to build research capacity, develop young researchers and to establish a vibrant and viable post-graduate programme at UZ. The long term goal of this project involves rural economic growth, job creation through agro-processing and phytopharmaceutical industries and lastly, human capital development.

in 2008, 36 million, or 63 percent, were due to NCDs, especially cardiovascular diseases, diabetes, cancers and chronic respiratory diseases.

The research will focuss on the state of NCDs in the Eastern Cape Province of south Africa and ways to map the epidemic from a clinical and public health perspectives with the aim of, reducing its major risk factors and improving the health care of people who already suffer from NCDs. The research also has as its objective identifying the level of the burden of the disease from a clinical and perceptive perspectives with the aim of developing means for the the Prevention and Control of NCDs with a focuses on the current status of NCDs which means the study will be both crosssection and longitudinal across different facilities and communities with the aim of assessing progress after five years of the project implementation to dtermine the impact of the interventions. One of the main objectives of this research project therefore is to provide a baseline for Eastern Cape Province on the current status of NCDs and their risk factors, as well as the current state of progress if any which the province is making to address these diseases in terms of policies and plans, infrastructure, surveillance and population-wide and individual interventions. The research also aims at disseminating a shared vision and road map for NCD prevention and control from a public health and clinical perspectives based on evidence from the data collected and analysed while building capacity at the same time.

The socioeconomic impact of NCDs has affected progress towards the UN Millennium Development Goals (MDGs). MDGs that target health and social determinants such as education and poverty have been negatively affected by the growing epidemic of NCDs and their risk factors. Lack of monitoring Accurate data are vital to reverse the rise in death and disability from NCDs. But many countries have little usable mortality data and weak surveillance systems and data on NCDs are often not integrated into national health information systems. Improving surveillance and monitoring must be a top priority in

the fight against NCDs. Three essential components of NCD surveillance constitute a framework that should be established and strengthened. These components are: a) monitoring exposures (risk factors); b) monitoring outcomes (morbidity and disease-specific mortality); and c) health system responses, which also include national capacity to prevent NCDs in terms of policies and plans, infrastructure, human resources and access to essential health care including medicines, (WHO, 2014). This research work as starting point aims to establish a baseline of NCDs using cross sectional approach and follow up sample over the years using clinical and public health perspectives using a longitudinal approach. Standardized core indicators for each of the three components should be adopted and used for monitoring and surveillance of behavioural and metabolic risk factors

The data collected will form a baseline for NCDs in the Eastern Cape Province. Following the data collected an analysis will be carried out which will inform a new way of dealing with people who suffer from NCDs and HIV/AIDs from the problem identification, design of interventions, implementation, monitoring and surveillance and finally a Health Impact Assessment which should deal with poorly designed interventions which could be confusing. The study will support the efforts of the government at improving health care to the population based on the evidence from the data collected and analysed in a scientific manner. Institution: Walter Sisulu University

PI: DR. CONSTANCE SEWANI-RUSIKE

Indigenous and traditional plant foods for health in the Eastern Cape

Indigenous plant foods that include wild leafy vegetables, wild fruits

and beverages are neglected and underutilized in the Eastern Cape. However, older members of the community continue to utilize

Eastern Cape Province. Six schools will be conveniently selected, two schools in each district one rural and urban systematically randomly and stratified by primary and secondary school. The WBOT, principals, life-orientation teachers, teachers and mothers/guardians including provincial leaders will be conveniently selected to participate in the study. Data will be collected using questionnaires, interviews and focus groups and analysis of documents. Qualitative and quantitative methods will be used to analyze data followed by interventions based on the results.

Institution: University of Limpopo

PI: PROFESSOR LESEILANE MAMPURU

The screening of indigenous medicinal plants using various in vitro and in vivo models to identify novel compounds, extracts and/or fractions that

can be developed into a pipeline of nutraceuticals, food supplements and potential drug leads for the management and treatment of cancer, type-2 diabetes and obesity. The Medicinal Plant Research Group in the Department of Biochemistry, Microbiology and Biotechnology (BMBT) at the University of Limpopo (UL) is comprised of Prof Leseilane Mampuru (Principal Investigator), Prof Matlou Mokgotho, Dr Vusi Mbazima, and Dr Victor Bagla. The funding awarded is multifaceted and is meant to enhance the research capacity and development of young scientists in the specialized and scarce-skilled area of medical biotechnology and related fields. The initiative strongly supports postgraduate training of students at both M & D levels and

intends to enable technology transfer from the highly resourced-collaborator laboratories to UL. The envisaged outcomes include increased publications thereby contributing to the generation of new scientific knowledge and to mitigate the knowledge gaps on the development, progression and treatment strategies of diseases under investigation. The development of new pharmaceutical products is another possible outcome. Indeed, the long-term goal and the collective collaborative effort by both the UL researchers and collaborators is to help harness and synergize the available expertise in order to build the scientific competence and human capital needed to discover, develop and commercialise a pipeline of nutraceuticals, food supplements and drug leads for the prevention and/or treatment of cancer, diabetes and obesity from indigenous African flora.

Institution: University of Venda

PI: PROFESSOR PASCAL O. BESSONG

Transmitted and Acquired HIV drug resistance in Limpopo Province

The study will determine the types and scope of drug resistant HIV in

individuals who are infected but not receiving antiretroviral treatment, and in individuals who are infected and receiving antiretroviral treatment in rural Limpopo. The study will provide data relevant to the implementation of drug resistance sentinel surveillance. It will also provide data on HIV treatment outcomes, and on the impact of uncharacterized mutations on the efficacy of first line treatment. Overall, the study will enhance our understanding of HIV drug resistance, which is important in sustaining the efficacy and success of first line treatment regimens.

Institutions: University of Venda

PI: DR LIZZY NETSHIKWETA

Determining the household environmental factors that affect the health of women and children and to develop and implement an adapted intervention strategy

that will contribute to the reduction of MMR and Child mortality rate in Limpopo province

Womens health is a critical area, which reflects national health standards and basic to womens advancement. The World Health Organization (2000) pointed that the maternal, perinatal mortality and morbidity levels are key indicators of the public health situation in a country. Hence, South Africa is committed to achieving the Millennium Development Goals (MDGs). The achievement of all the MDGs has important implications for the health and well-being of women and children, MDGs 1, 3, 4, 5 and 6 are of particular importance. Guided by the MDGs, South Africa aims, by 2015, to have reduced child mortality to 20 per 1000 live births, and the maternal mortality ratio (MMR) to 38 per 100 000 live births.

Two research approaches will be used, namely, qualitative for exploring the socio-cultural aspect and quantitative to determine the environmental factors. Both approaches will be implemented concurrently by two teams in one district. The first district will be Vhembe (2015-2016), Mopani (2016-2017) and lastly Capricorn (2017-2018) and in 2019 will focus on the development of strategy and finalization of the project. Population will comprise women, girls and Community Health workers, other community members in villages, Ward councillors & Chiefs/headman (traditional leaders) & Traditional Health Practitioners, Traditional Birth Attendants. Data will be analysed using Statistical Package for Social Sciences (SPSS) version 22.0. In qualitative design participants will be sampled purposively. Qualitative data will be analysed using Tesch

steps of open coding. Ethical measures, reliability; validity and trustworthiness will be considered throughout the study.

Institution: Walter Sisulu University

PI: DR TEKE APALATA

Evolution of HIV-infected Patients Receiving HAART and Quality of HIV/AIDS Care Initiated by Nurses at Primary Healthcare Level in Eastern Cape, South Africa.

The present study plans to provide a particular insight of the impact of task shifting for HIV care on immunological, virological, and clinical outputs in HIV-infected patients on HAART, attending healthcare facilities in O.R. Tambo district Eastern Cape.

In an effort to better understand factors associated with ART non-suppressed cases and ART-suppressed non-controllers, the present study plans to measure the adherence index as recommended by the Centre for Adherence Support Evaluation (CASE).

Furthermore, patients infected with HIV have an increased risk of cardiovascular diseases due to increased inflammation and persistent immune activation. As part of quality care, WHO suggests that chronic diseases, mainly cardio-vascular diseases and metabolic syndrome should be monitored among patients on HAART. WHO projects that ischemic heart disease will be the leading cause of death in the general population in both low- and high-income countries by 2030. Therefore, there is an urgent need of identifying earlier markers able to predict the occurrence of cardiovascular diseases and other chronic conditions in HIV-infected patients.

The analysis of the obtained data will highlight the importance of adopting a system thinking

approach in designing, implementing and evaluating health policies to mitigate some of the design issues or system bottle-necks that may impede their successful implementation or risk to present an incomplete or misleading picture of their impact. Hence, this study will support the efforts of the South African department of health through its National Health Insurance (NHI) innovative system in improving quality of healthcare services.

Institution: Walter Sisulu University

PI: PROFESSOR LECH BANACH

Investigation of biomarkers in earlier detection of Oesophageal Cancer in South Africa - Progression of normal oesophageal epithelium to

squamous cell carcinoma in Eastern Cape: Extent of DNA damage, ezrin expression and clinical characteristics.

Squamous cell carcinoma of the oesophagus (SCCE) ranks high among all cancers in black South African men and second cancer in black South African women. The incidence of SCCE is reported to be high in the region of former Transkei. The latest data published by MRC based on PROMEC Cancer Registry 1992-2002 study performed in ten municipalities in this region, revealed that SCCE in males accounts for 42.2 % of total cancers, following by lung cancer 7.9%. Among females SCCE was second (31.5%) after cervical cancer (33%). SCCE incidence is much higher than those observed in other parts of Africa or for the black population in the USA.

Many reports were published on studies of SCCE causative agents and risk factors in blacks in South Africa including Transkei region. These include diet, contaminated food and habits (drinking and smoking). However carcinogenesis of early development of SCCE is unknown. During tumour initiation, development and progression, various cellular

processes are involved such as cell adhesion, cell survival, motility and signal transduction. Association of actin filaments with plasma membranes is important for the regulation of cell morphology and cell morphology and local deformations. Ezrin, a member of the ezrin-radixin-moesin (ERM) family is one of the proteins which cross links the plasma membrane to actin filament. Recent studies from China showed that redistribution or reduced expression of ezrin both at mRNA and protein levels in SCCE may play role in initiation and progression of SCCE.

Our research project includes studies on the role of ezrin in South African black patients and also role of oxidative stress by study of DNA damage by the presence of in situ 8-hydroxy-deoxyguanosine (8-OhdG). The results will be correlated with demographic data and stage and grade of tumour.

Institutions: Walter Sisulu University

PI: DR WEZILE CHITHA

The Management and building Of Bridges for Selected Non Communicable Diseases and HIV Risk Factors, Morbidity, and Mortality in the Eastern Cape Province:

A community-, hospital-, Laboratory Study

Non-communicable diseases (NCDs) are the leading global causes of death, causing more deaths than all other causes combined, and they strike hardest at the worlds low- and middle-income populations. These diseases have reached epidemic proportions, yet they could be significantly reduced, with millions of lives saved and suffering avoided, through reduction of their risk factors, early detection and timely treatments. Target audiences include policy-makers, health officials, academia, relevant non-health sectors, development agencies and civil society. According to the World Health Organisation, (2013:1) of Burden of 57 million global deaths