Background The objective of this study was to identify risk factors for ongoing community transmission of tuberculosis (TB) in two densely populated urban communities with a high incidence rate of TB in Cape Town, South Africa. Methods Between 1993 and 1998 DNA fingerprints of mycobacterial isolates from TB patients were determined by restriction fragment length polymorphism (RFLP). Cases whose isolates shared identical fingerprint patterns were considered to belong to the same cluster and to be attributable to ongoing community transmission. Results The average annual notification rate of new smear positive TB was 238/100 000. In all, 1023/1526 reported patients were culture positive, and RFLP was available for 768 (75%) of the isolates from these patients. Since some patients experienced more than one infection during the study period, 797 cases were included in the analysis. Of the cases, 575/797 (72%) were clustered. Smear-positive cases and those who were retreated after default were more likely to be clustered than smear-negative and new cases, respectively. Patients from Uitsig were more often part of large clusters than were patients from Ravensmead. Age, sex, year of diagnosis, and outcome of disease were not risk factors for clustering, nor for being the first case in a cluster, although various analytical approaches were used. Conclusions The incidence and proportion of cases that are clustered in this area are higher than reported elsewhere. An overwhelming majority of TB cases in this area is attributed to ongoing community transmission, and only very few to reactivation. This may explain the lack of demographic risk factors for clustering.

Future land cover changes may result in adjustments to biophysical drivers impacting on net ecosystem carbon exchange (NEE), catchment water use through evapotranspiration (ET), and the surface energy balance through a change in albedo. The Land Change Modeller (Idrisi Terrset 18.08) and land cover for 2000 and 2014 are used to create a future scenario of land cover for two catchment with different land management systems in the Eastern Cape Province for the year 2030. In the S50E catchment, a dualistic farming system, the trend shows that grasslands represented 57% of the total catchment area in 2014 decreasing to 52% by 2030 with losses likely to favour a gain in woody plants and cultivated land. In T35B, a commercial system, persistence of grasslands is modelled with approximately 80% coverage in both years, representing a more stable system. Finally, for S50E, NEE and ET will increase under this land cover change scenario leading to increased carbon sequestration but less water availability and corresponding surface temperature increases. This implies that rehabilitation and land management initiatives should be targeted in catchments under a dualistic farming system, rather than those which are predominantly commercial systems.

In an ongoing molecular epidemiology study, human immunodeficiency virus-negative patients with first-time pulmonary tuberculosis from a high-incidence community were enrolled. Mycobacterium tuberculosis strains were identified by restriction fragment length polymorphism analysis with two fingerprinting probes. Of 131 patients, 3 (2.3%) were shown to have a mixture of strains in one or two of their serial cultures. This study further investigated these cases with disease caused by multiple M. tuberculosis strains in the context of the molecular epidemiology of the study setting.