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Biomedical subjects

C B Ijsselmuiden

Publications and source records attributed to C B Ijsselmuiden.

At least 19 recordsLinked to original sources
PubMed1998

Adding alpha-amylase to weaning food to increase dietary intake in children. A randomized controlled trial.

The addition of alpha-amylase to a food supplement for weaning-age children was proposed as an alternative to traditionally prepared Amylase-Rich Foods (ARF) for reducing the dietary bulk of weaning diets. In a self-controlled clinical trial including 30 healthy children, aged 10-24 months, the effect of the addition of alpha-amylase and extra cereal to a diet including three meals, was determined in terms of dietary intake. A mean increased intake of 23.8 per cent in energy and 10.4 per cent in protein was found. The addition of commercial alpha-amylase to maize-based weaning foods is a useful method of increasing the nutritional value of weaning diets.

Cross-Over Studies↗
PubMed1990

Vaccination status and seroprevalence of measles and polio antibodies in 1-6-year-old children in the Elim health ward of Gazankulu.

Seroprevalence was used to evaluate the vaccination programme in the Elim health ward of Gazankulu. Antibodies to measles and polio were measured in 1-6-year-old children together with vaccination status. In 224 children studied using a cluster sampling technique, vaccine coverage was found to be 86% for measles and over 90% for polio and diphtheria, pertussis and tetanus. It was difficult to determine vaccine failure rates accurately; 21% of children were seronegative after having received measles vaccine, 32% who had apparently not been vaccinated had antibodies, while a total of 27% had no measles antibodies. Thirty-nine per cent of children failed to demonstrate antibodies to all 3 types of poliovirus after having received 3 doses of oral polio vaccine, 94% had immunity against type 2, and 76% and 74% were immune to types 1 and 3, respectively. Reasons for diminished effectiveness of vaccination programmes are cited; in this study it was probably due to decreased vaccine efficacy related to inadequacies in the cold-chain. Recommendations are that seroprevalence studies are useful, but only after vaccine coverage and the cold-chain have been optimised.

Antibodies, Viral↗
PubMed1990

Vaccination--coverage of under-fives, validity of records, and the impact of mass campaigns in the Edendale/Vulindlela district of KwaZulu.

Recent epidemics of poliomyelitis and measles in the Edendale/Vulindlela district of KwaZulu spurred an investigation into the causes of vaccination failure. Vaccination coverage achieved by routine clinic services and by two mass campaigns was assessed. The validity of routine clinic vaccination records was also determined. Using a modified 30 x 7 random cluster sampling technique, 224 children aged 1-5 years were studied. Of these, 62% had a 'Road to Health' card. Best estimates show that 87% had had BCG, 62% three doses of diphtheria, pertussis and tetanus and polio, and 55% measles vaccine. The mass campaigns raised coverage for measles by 26%, and that for polio by 27%. Coverage estimates made from routine clinic data were consistently 13-25% higher than from this survey. This discrepancy is unfortunate, since it could lead to complacency if certain targets are apparently achieved using only clinic records, and points to the need for regular population-based surveys in all but the best organised health services. Inadequate vaccination coverage alone can explain the epidemics of polio and measles. The reasons for this, in the presence of an adequate clinic infrastructure, need to be assessed urgently to prevent further outbreaks.

Child, Preschool↗
PubMed1990

Qualitative evaluation of an AIDS health education poster. A rapid assessment method for health education materials.

In January 1989, the Johannesburg City Health Department developed an AIDS education poster. The poster was adapted from a cartoon in the Sowetan newspaper and was formally evaluated before its final production. As a result of this evaluation further editing and restructuring of the poster proved necessary. The methodology used in the evaluation is outlined, and some of the findings that emerged during the evaluation are discussed, since few formal evaluations of health education material seem to have been documented in South Africa. This study highlights the importance of formative evaluation of printed health educational media by a sample of the target audience before production and distribution.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Knowledge, beliefs and practices among black goldminers relating to the transmission of human immunodeficiency virus and other sexually transmitted diseases.

The Chamber of Mines of South Africa employs approximately 750,000 miners from all over southern Africa. Sero-surveys in 1986 showed that, depending on geographical area of origin, between 0.02% and 3.76% of miners were positive for human immunodeficiency virus (HIV) antibodies. As a consequence, an intensive education campaign to stop the spread of HIV infection was launched. A study was undertaken to establish a valid baseline level of knowledge about black miners' beliefs, attitudes and practices related to HIV infection, acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs), and to recommend appropriate changes to the educational efforts of the Chamber of Mines. A structured, pre-tested questionnaire was used to interview in their home language 429 systematically sampled black miners from four different mines. The most relevant findings were that younger age, not being married and how general education predispose to contracting STDs, while a feeling of being at risk for contracting HIV infection is positively correlated with level of education. Close friends were the most important source of information on STDs, but the media and medical staff were the most important sources of information on AIDS/HIV infection. Condoms were used by 31% of respondents, while the main reasons for non-use were trust in the sexual partner and lack of availability. Promotion of a stable family life for miners may significantly impact on the transmission of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Reducing health care costs--potential and limitations of local authority health services.

Local authorities (LAs) currently provide preventive and promotive services. It is argued that, by extending the role of the LA to the provision of comprehensive services, including ambulatory and hospital curative care, both the quality and the cost-effectiveness of health care would be improved. Making health care the responsibility of the LA would minimise fragmentation, allow for the provision of a number of services that currently are neglected because they fall through the gap that exists between preventive and curative services, and result in the more effective use of personnel currently restricted to providing preventive care only. LAs offer an appropriate structure for effective community control over the health services, and are more likely to be sensitive to local needs and demands. In addition, their administrative proximity to other LA departments responsible for housing, town planning and parks and recreation allows for an effective multisectoral approach to health. The positive aspects of LA care can only be achieved in the context of racially integrated services provided by an LA elected by universal adult franchise. Smaller LAs may need to be grouped together in larger units for the purpose of achieving satisfactory economies of scale in the provision of health care.

Community Participation↗
PubMed1989

Survey of oral fluid therapy practices in South Africa.

The objectives of this study were to document the official oral fluid therapy (OFT) policies of all the ministries of health in South Africa and of the four provincial authorities, to determine what methods of OFT are used in hospitals providing paediatric care, to determine the OFT methods recommended by hospital staff for use at home, to establish the level of support for the idea of one national policy for OFT and to determine what senior academic paediatricians think about these issues. We conducted structured telephonic interviews of professional staff in charge of paediatric wards in 159 randomly selected hospitals providing general inpatient care. The hospitals were stratified as private, provincial and 'homeland'. We also interviewed the directors-general or the secretaries or their deputies in each ministry of health as well as directors of hospital services or their deputies in each one of the four provinces of the Republic. Lastly, we spoke to the academic heads of paediatric departments in each of the country's eight medical schools. The results show that the use of OFT for inpatient care of diarrhoeal disease is far from universal, and that the picture with regard to promotion of home OFT is even less favourable. We identified an unacceptable diversity in the OFT methods being promoted as well as a degree of resistance to the development of one national policy. We recommend that one policy, based on the recommendations of the South African Paediatric Association, be adopted by all health authorities in South Africa as a matter of urgency.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluid Therapy↗
PubMed1989

Knowledge and practice of oral rehydration therapy in a village in Gazankulu after the introduction of the Morley spoon.

Oral rehydration therapy (ORT) is effective in preventing dehydration during acute gastro-enteritis, thus decreasing morbidity and mortality. There is, however, reluctance among mothers and child-minders to use ORT when faced with the crisis of acute diarrhoea. This study describes the effects of a health education campaign, using the Morley (sugar and salt) spoon, on knowledge and practice of ORT in one community in Gazankulu, and compares care group (CG) with non-care group (non-CG) members. Two years after its introduction, the Morley spoon was still the most commonly used method of preparing oral rehydration solution (ORS). Ninety-seven per cent of CG members could produce the spoon when asked to, as opposed to 55% of non-CG members (P less than 0.001). Eighty-two per cent of respondents had actually used ORT in the past. Fifty-three per cent mixed the ORS incorrectly. Sixty-one per cent believed that ORT would stop diarrhoea and 29% that it was used for rehydration. Only 26% would give ORS after every loose stool, but 54% would give ORT until the diarrhoea has stopped. Fifty-nine per cent of women would feed their children soft porridge, 20% would continue breast-feeding, and 2% would starve the child while it had diarrhoea. Women who had retained the Morley spoon showed a greater knowledge of ORT (P less than 0.005) and had used ORT more often in the past (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Fluid Therapy↗
PubMed1988

AIDS and South Africa--towards a comprehensive strategy. Part I. The world-wide experience.

In this, the first of a three-part series of articles in which we propose steps towards a comprehensive strategy for the control of HIV infection, we consider briefly the world-wide experience with the HIV epidemic. Our objective is to highlight the problems and controversial issues which are pertinent to strategies for the control of HIV infection. We focus on problems of case-definition, differences between 'African' and 'Western' AIDS and the implications for South Africa, and problems with sensitivity and specificity of tests used at present, particularly in the context of false positivity in a community with a low prevalence of HIV infection. We consider some of the ethical issues, including the need for adequate counselling, the need for informed consent before testing, and the centrality of confidentiality, particularly in the context of possible victimisation and neglect of HIV-positive individuals. Differences between 'notification' and 'reporting' are emphasised. Recommendations are made regarding these problems.

Acquired Immunodeficiency Syndrome↗
PubMed1988

AIDS and South Africa--towards a comprehensive strategy. Part II. Screening and control.

In this, the second of a three-part series of articles in which we propose steps towards a comprehensive strategy for the control of HIV infection, we consider controversies relating to screening for HIV, the indications for and desirability of mandatory testing of certain groups at risk, and the place of voluntary testing in the control of HIV transmission and infection. Key recommendations are that mandatory testing of donors of blood and other vital tissues, patients on haemodialysis and haemodialysis unit staff is justified, and that children put up for adoption may require testing. We make further recommendations regarding HIV testing as a prerequisite for life insurance and recommend that voluntary testing be offered, supported by adequate pre- and post-test counselling. We consider that all health care workers should accept as their moral obligation the care and management of HIV-infected individuals, and that they should be adequately educated and skilled in such work. These recommendations were reached largely by consensus, although there were occasions when individual authors condoned recommendations with which they did not personally agree.

Acquired Immunodeficiency Syndrome↗
PubMed1988

AIDS and South Africa--towards a comprehensive strategy. Part III. The role of education.

In this, the third of a three-part series of articles in which we emphasise the urgent need for and propose steps towards a comprehensive strategy for the control of HIV infection, we highlight the fundamental importance of an education campaign and the three critical essentials for a successful campaign. The first concerns the responsibility of the State in administering the programme, in providing adequate funds on an on-going basis and in delegating responsibility for the day-to-day activities to the appropriate local authorities and non-governmental organisations. The second relates to the need to establish a multidisciplinary AIDS group representative of groups at risk and of relevant scientific expertise to ensure that appropriate policies are developed and that changes to policy are made in response to changing circumstances, based on sound epidemiological, managerial and educational principles. These must take particular account of circumstances peculiar to South Africa, such as the migrant labour system, which may promote both promiscuity and homosexuality. Thirdly, the need to ensure open, appropriate communication with the groups at risk and the public at large in the development, implementation and evaluation of the education campaign is emphasised. In this context we plead for more psychosocial research. These recommendations were reached largely by consensus, although there were occasions when individual authors condoned recommendations with which they did not personally agree.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Prevalence and causes of blindness in the northern Transvaal.

During November 1985 a survey was carried out to determine the prevalence and causes of blindness in the Elim Hospital district of Gazankulu in the Northern Transvaal, South Africa, and to assess the Eye Department's effectiveness in preventing blindness. Using a random cluster sample technique, we screened 18,962 of the estimated 71,200 inhabitants of the district (26.6%). We found 109 blind people. The prevalence of blindness was 0.57% (95% confidence interval 0.46%-0.68%). The main causes of blindness were senile cataract (55%), corneal scarring due to trachoma (10%), uncorrected aphakia (9%), and open-angle glaucoma (6%). There were 14 aphakic blind persons who did not have aphakia glasses (43% of all persons operated on for cataract). Women had a significantly higher prevalence of blindness than men. After the age of 60 years the prevalence of blindness increased sharply. Women were 1.6 times less likely to have undergone cataract surgery than men. The two most effective steps to reduce the prevalence of blindness in the Elim district further are to provide aphakia glasses to all aphakic patients and to improve the accessibility of the Eye Department's surgical services.

Adolescent↗
PubMed1987

Notification of five of the EPI target diseases in South Africa. An assessment of disease and vaccination reporting.

The incidence of 5 of the 6 EPI target diseases, diphtheria, tetanus, poliomyelitis, measles and tuberculosis, in South Africa is examined. Incidence is linked to vaccination coverage and an assessment of municipal vaccination coverage and programme monitoring is made. Diphtheria incidence has decreased sharply and this is probably due to vaccination. A change in the cyclical pattern of polio incidence may be due to improved vaccination. No influence of vaccination could be detected with respect to measles, tetanus and tuberculosis. Vaccination programmes report results as 'total doses given' and not as coverage rates. Improvements in three major areas, i.e. vaccination coverage, programme monitoring and evaluation and programme co-ordination are proposed.

Diphtheria↗
PubMed1987

Analysis of an immunisation programme in a rural area.

An immunisation programme in a rural area of southern Africa is analysed. The combination of fixed and mobile immunisation points is discussed with reference to staffing levels, patient convenience, vaccine handling, costs and efficiency. A system of community involvement in the programme is assessed. Mobile immunisation teams to complement fixed clinic services, and active community involvement are suggested for immunisation programmes in rural areas.

Africa, Southern↗
PubMed1987

Vaccine cold-chain status in the Elim health ward of Gazankulu.

The vaccine cold-chain is a fundamental component of any immunisation programme. This study used chemical-based temperature indicators to monitor the cold-chain constantly in the Elim Hospital health ward of Gazankulu. It was found that the cold-chain was adequately maintained at the hospital, but that as vaccine travelled towards the periphery severe breaks in the cold-chain occurred. Eighteen per cent of vaccines at the Elim Hospital store and up to 90% at the periphery were potentially exposed to temperatures high enough and for a sufficient length of time to have affected their potency. More emphasis needs to be placed on maintaining the cold-chain if we are to reach to EPI's goal of immunisation for all children by the year 1990.

Cold Temperature↗
PubMed1987

Vaccination status of children aged 12-23 months in the Mosvold health ward of KwaZulu.

Using the random cluster sampling technique of the EPI, 210 children of 12-23 months were selected and their vaccination records were examined. Fifty-one (24%) had no vaccination record and 32 of them (15%) were never vaccinated. Using a 'worst' and 'best' estimate analysis it was found that 74-83% had had BCG, 47-56% had had 3 doses of DPT, 48-57% had had 3 doses of polio and 47-56% had had 1 dose of measles vaccine. Between 28-31% of those who received a first dose of DPT or polio vaccine did not receive a third dose. This 'drop-out' effect increased with increasing distance between children's homes and the nearest clinic, as did vaccination coverage in general. As a result of this study, several measures will be undertaken to improve health care delivery in this area. These include the organisation of a mass immunisation campaign later this year, the initiation of more mobile clinics and the training of community health workers.

Health Surveys↗