Objective:Transplant a liver from an HIV-positive mother to her HIV-negative child to save the child's life.Design:A unique case of living donor liver transplantation from an HIV-positive mother to her HIV-negative child in South Africa. Two aspects of this case are ground-breaking. First, it involves living donation by someone who is HIV-positive and second it involves controlled transplant of an organ from an HIV-positive donor into an HIV-negative recipient, with the potential to prevent infection in the recipient.Methods:Standard surgical procedure for living donor liver transplantation at our centre was followed. HIV-prophylaxis was administered preoperatively. Extensive, ultrasensitive HIV testing, over and above standard diagnostic assays, was undertaken to investigate recipient serostatus and is ongoing.Results:Both mother and child are well, over 1 year posttransplantation. HIV seroconversion in our recipient was detected with serological testing at day 43 posttransplant. However, a decline in HIV antibody titres approaching undetectable levels is now being observed. No plasma, or cell-associated HIV-1 DNA has been detected in the recipient at any time-point since transplant.Conclusion:This case potentially opens up a new living liver donor pool which might have clinical relevance in countries where there is a high burden of HIV and a limited number of deceased donor organs or limited access to transplantation. However, our recipient's HIV status is equivocal at present and additional investigation regarding seroconversion events in this unique profile is ongoing.

AbstractGlobally, policymakers often describe informal settlements and slums in terms of health problems. In this paper we trace the way housing and planning have been linked to health concerns in the history of South Africa and we assess post-apartheid literature on the topic. We note that researchers continue to rely on a biomedical understanding of the relationship between housing, planning and health although, we argue, the links between them are tenuous. We propose the capabilities approach as a way to understand this relationship. Reframing the relationship between housing, planning and health within the capabilities approach may improve the current understanding of this link.AimThis paper discusses the historical links between housing, planning and health in South Africa, assesses post-apartheid policy, and reviews post-apartheid literature on the relationship between housing, planning and health.Results and conclusionsWe find it is assumed that the link between housing, planning and health is a biomedical concern and not a social concern. We argue that scholars thinking about this relationship should consider the opportunities embedded in the capabilities approach to understand health outside the biomedical frame.

ObjectivesThe performance of mortality prediction models remain a challenge in lower- and middle-income countries. We developed an artificial neural network (ANN) model for the prediction of mortality in two tertiary pediatric intensive care units (PICUs) in South Africa using free to download and use software and commercially available computers. These models were compared to a logistic regression model and a recalibrated version of the Pediatric Index of Mortality 3.DesignThis study used data from a retrospective cohort study to develop an artificial neural model and logistic regression model for mortality prediction. The outcome evaluated was death in PICU.SettingTwo tertiary PICUs in South Africa.Patients2,089 patients up to the age of 13 completed years were included in the study.InterventionsNone.Measurements and Main ResultsThe AUROC was higher for the ANN (0.89) than for the logistic regression model (LR) (0.87) and the recalibrated PIM3 model (0.86). The precision recall curve however favors the ANN over logistic regression and recalibrated PIM3 (AUPRC = 0.6 vs. 0.53 and 0.58, respectively. The slope of the calibration curve was 1.12 for the ANN model (intercept 0.01), 1.09 for the logistic regression model (intercept 0.05) and 1.02 (intercept 0.01) for the recalibrated version of PIM3. The calibration curve was however closer to the diagonal for the ANN model.ConclusionsArtificial neural network models are a feasible method for mortality prediction in lower- and middle-income countries but significant challenges exist. There is a need to conduct research directed toward the acquisition of large, complex data sets, the integration of documented clinical care into clinical research and the promotion of the development of electronic health record systems in lower and middle income settings.

Background: The importance of a child's first 1000 days has now been widely accepted by the medical fraternity. Yet, we do not know much about caring practices in low-resource settings.Aim: This study aimed to investigate the caring capabilities of mothers in a low-resource setting.Method: In this study, in-depth interviews were conducted with 18 mothers with children aged 30 months or younger to better understand the arrangements, means and ends that inform developmental health in a low-resource setting in South Africa.The study was conducted in a low-income area, the former black township of Mangaung in Bloemfontein. The mothers were recruited via pamphlets, and two interviews followed. Because of Covid-19, interviews took place via mobile phones, in Sesotho, the local language in the area. Trained fieldworkers conducted, translated and transcribed the interviews. We used thematic analysis and the capabilities approach as the theoretical framework to analyse the responses from the mothers.Findings: We used the following organizing themes: pregnancy and ante-natal care, nutrition, cognitive and physical development, the home environment and access to health care. Although short-term reactions to pregnancy were often negative, the longer-term responses showed that the respondents have agency. Most of them could change their nutrition habits, breastfeed and receive adequate nutrition support from the public health system. Most experienced joy when their children reached milestones (cognitive and others), although they became anxious if milestones were not reached. They emphasized children's play and had dreams for their children's futures. Technology was often mentioned as playing a role in their children's development. A large proportion of the respondents had disrupted homes (because of absent or abusive fathers), but some had stable homes. Most of them showed substantial capability to overcome adverse home environments. The public

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