Background South Africa has a high burden of perinatal common mental disorders (CMD), such as depression and anxiety, as well as high levels of poverty, food insecurity and domestic violence, which increases the risk of CMD. Yet public healthcare does not include routine detection and treatment for these disorders. This pilot study aims to evaluate the implementation outcomes of a health systems strengthening (HSS) intervention for improving the quality of care of perinatal women with CMD and experiences of domestic violence, attending public healthcare facilities in Cape Town. Methods Three antenatal care facilities were purposively selected for delivery of a HSS programme consisting of four components: (1) health promotion and awareness raising talks delivered by lay healthcare workers; (2) detection of CMD and domestic violence by nurses as part of routine care; (3) referral of women with CMD and domestic violence; and (4) delivery of structured counselling by lay healthcare workers in patients’ homes. Participants included healthcare workers tasked with delivery of the HSS components, and perinatal women attending the healthcare facilities for routine antenatal care. This mixed methods study used qualitative interviews with healthcare workers and pregnant women, a patient survey, observation of health promotion and awareness raising talks, and a review of several documents, to evaluate the acceptability, appropriateness, feasibility, adoption, fidelity of delivery, and fidelity of receipt of the HSS components. Thematic analysis was used to analyse the qualitative interviews, while the quantitative findings for adoption and fidelity of receipt were reported using numbers and proportions. Results Healthcare workers found the delivery and content of the HSS components to be both acceptable and appropriate, while the feasibility, adoption and fidelity of delivery was poor. We demonstrated that the health promotion and awareness raising component improved women’s attitudes towards seeking help for mental health conditions. The detection, referral and treatment components were found to improve fidelity of receipt, evidenced by an increase in the proportion of women undergoing routine detection and referral, and decreased feelings of distress in women who received counselling. However, using a task-sharing approach did not prove to be feasible, as adding additional responsibilities to already overburdened healthcare workers roles resulted in poor fidelity of delivery and adoption of all the HSS components. Conclusions The acceptability, appropriateness and fidelity of receipt of the HSS programme components, and poor feasibility, fidelity of delivery and adoption suggest the need to appoint dedicated, lay healthcare workers to deliver key programme components, at healthcare facilities, on the same day.

Background Ventilation rates are a key determinant of the transmission rate of Mycobacterium tuberculosis and other airborne infections. Targeting infection prevention and control (IPC) interventions at locations where ventilation rates are low and occupancy high could be a highly effective intervention strategy. Despite this, few data are available on ventilation rates and occupancy in congregate locations in high tuberculosis burden settings. Methods We collected carbon dioxide concentration and occupancy data in congregate locations and public transport on 88 occasions, in Cape Town, South Africa. For each location, we estimated ventilation rates and the relative rate of infection, accounting for ventilation rates and occupancy. Results We show that the estimated potential transmission rate in congregate settings and public transport varies greatly between different settings. Overall, in the community we studied, estimated infection risk was higher in minibus taxis and trains than in salons, bars, and shops. Despite good levels of ventilation, infection risk could be high in the clinic due to high occupancy levels. Conclusion Public transport in particular may be promising targets for infection prevention and control interventions in this setting, both to reduce Mtb transmission, but also to reduce the transmission of other airborne pathogens such as measles and SARS-CoV-2.

BackgroundData on social contact patterns are widely used to parameterise age-mixing matrices in mathematical models of infectious diseases designed to help understand transmission patterns or estimate intervention impacts. Despite this, little attention is given to how social contact data are collected and analysed, or how the types of contact most relevant for transmission may vary between different infections. In particular, the majority of studies focus on close contacts only – people spoken to face-to-face. This may be appropriate for infections spread primarily by droplet transmission, but it neglects the larger numbers of ‘shared air’ casual contacts who may be at risk from airborne transmission of pathogens such as Mycobacterium tuberculosis, measles, and SARS-CoV-2.MethodsWe conducted social contact surveys in communities in two provinces of South Africa in 2019 (KwaZulu-Natal and Western Cape). In line with most studies, we collected data on people spoken to (close contacts). We also collected data on places visited and people present, allowing casual contact patterns to be estimated. Using these data, we estimated age mixing patterns relevant for i) droplet and ii) non-saturating airborne transmission. We also estimated a third category of pattern relevant for the transmission of iii) Mycobacterium tuberculosis (Mtb), an airborne infection where saturation of household contacts plays an important role in transmission dynamics.ResultsEstimated contact patterns by age did not vary greatly between the three transmission routes/infections, in either setting. In both communities, relative to other adult age groups, overall contact intensities were lower in 50+ year olds when considering contact relevant for non-saturating airborne transmission or the transmission of Mycobacterium tuberculosis than when considering contact relevant for droplet transmission.ConclusionsOur findings provide some reassurance that the widespread use of close contact data to parameterise age-mixing matrices for transmission models of airborne infections may not be resulting in major inaccuracies. The contribution of older age groups to transmission may be over-estimated, however. There is a need for future social contact surveys to collect data on casual contacts, to investigate whether our findings can be generalised to a wider range of settings, and to improve model predictions for infections with substantial airborne transmission.