The ethics of international recruitment.
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Editorial↗
Biomedical subjects
I Couper
Publications and source records attributed to I Couper.
AIDS--the way forward.
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AIDS-Related Opportunistic Infections↗
A simple telemedicine system using a digital camera.
Radiographs on a viewing box were photographed at a remote hospital in South Africa using a digital camera with a resolution of 1024 x 768 pixels at 24-bit colour depth. The resultant images were stored in JPEG format and transmitted as email attachments to be read on a PC monitor by radiologists in Durban and Cape Town. Twenty-seven images were received, of which 23 were of diagnostic quality (85%). The mean file size was 120 kByte. For quality control purposes, 100 chest radiographs were photographed at a base hospital and read by a radiologist blinded to the diagnosis. In this study 96 images were of diagnostic quality (96%) and the correct diagnosis was made in 90 cases (94%). Incorrect readings were made in six cases (6%): small pulmonary nodules (less than 1 cm in diameter) were missed in five cases and in one case early apical tuberculosis was missed. Digital camera technology permits simple, inexpensive telemedicine. Limited spatial resolution is a concern when reading chest images with small pulmonary nodules and infiltrates.
Humans↗
The future of rural medicine in South Africa.
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Democracy↗
Causes of death in a rural hospital in South Africa.
OBJECTIVES: To determine the causes of death at Manguzi Hospital, in rural North Kwa-Zulu, over a three year period, July 1992 to June 1995. DESIGN: A retrospective study using hospital records. SETTING: Rural hospital. SUBJECTS: Of admissions, total deaths numbered 1,275 (703 males, 572 females), of which 143 were from accidents and trauma. MAIN OUTCOME MEASURES: Deaths. RESULTS: Of children under five years there were 430 deaths (34% of the total); 236 (55%) were from perinatal causes. Infections, chiefly gastro-enteritis, caused 124 (29%) of deaths. Of children five to 12 years, there were 39 deaths (3% of the total); 12 (44%) died from infections. Of adolescents and adults aged 13 to 59 years, there were 377 deaths (29% of the total); of these, accidents and trauma caused 88 (23%), and infectious diseases 82 (22%). In the elderly, 60 years and over, there were 429 deaths (34% of the total); infectious diseases predominated, 103 (24%). In this age group, there were 71 deaths (17%) from cerebrovascular disease; 63 (15%) from cardiac failure; 46 (11%) from cancer, but none from coronary heart disease. Of the 143 non-natural deaths, 30 (21%) were from assault, and 28 (20%) from motor vehicle and pedestrian accidents. CONCLUSION: The high proportion of deaths from infections, as likewise reported from other rural hospitals, emphasizes the need for increased public health endeavours for furthering immunizations, health education, provision of water and sanitation, and tuberculosis control programmes.
Adolescent↗
Promote the community health worker.
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Community Health Workers↗
The effect of different anthelmintic treatment regimens combined with iron supplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial.
A randomized controlled trial in KwaZulu-Natal (South Africa) of 428 primary-school pupils (stratified into 6 groups by age, sex and intervention) measured the effect of different anthelmintic treatments and iron supplementation regimens provided twice at 6-monthly intervals for 1 year (1996/97). Half the pupils received iron supplementation (ferrous fumarate 200 mg weekly for 10 weeks). Pupils received 2 anthelmintic regimens, either (i) albendazole 400 mg plus praziquantel 40 mg/kg or (ii) albendazole 400 mg on 3 consecutive days plus praziquantel 40 mg/kg or (iii) placebo. Baseline prevalences of Ascaris 55.9%, Trichuris 83.6%, hookworm spp. 59.4%, were reduced after 12 months for single-dose albendazole treatment to Ascaris 17.4% (P < 0.005), Trichuris 61.5% (NS), hookworm spp. 0% (P < 0.005), and for triple-dose albendazole treatment to Ascaris 14.8% (P < 0.005), Trichuris 25.0% (P < 0.01), hookworm 0% (P < 0.005). Schistosoma haematobium 43.4% was reduced among treated groups to 8.3% (P < 0.005). There were no significant changes in the anthropometry of the different treatment groups at either 6 or 12 months post treatment. Twelve months after treatment there was a significant increase in haemoglobin levels (P = 0.02) among pupils receiving triple-dose albendazole, praziquantel and ferrous fumarate; pupils receiving no anthelmintic treatment showed a significant decrease as did pupils who received triple-dose albendazole and praziquantel but no iron. Regular 6-monthly anthelmintic treatment significantly reduced the prevalence of Ascaris, hookworm spp. and S. haematobium infections (P < 0.05). Triple-dose treatment for Trichuris was significantly more effective than a single dose of albendazole 400 mg (P = 0.002). In areas with schistosomiasis, hookworm infection and high prevalence of Trichuris infection, combination treatment with praziquantel, triple-dose albendazole, plus iron supplementation, is likely to improve pupils' health and haemoglobin levels.
Adolescent↗