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Biomedical subjects

J S Gear

Publications and source records attributed to J S Gear.

At least 19 recordsLinked to original sources
PubMed2000

Validation and application of verbal autopsies in a rural area of South Africa.

OBJECTIVE: To validate the causes of death determined with a single verbal autopsy instrument covering all age groups in the Agincourt subdistrict of rural South Africa. METHODS: Verbal autopsies (VAs) were conducted on all deaths recorded during annual demographic and health surveillance over a 3-year period (1992-95) in a population of about 63 000 people. Trained fieldworkers elicited signs and symptoms of the terminal illness from a close caregiver, using a comprehensive questionnaire written in the local language. Questionnaires were assessed blind by three clinicians who assigned a probable cause of death using a stepwise consensus process. Validation involved comparison of VA diagnoses with hospital reference diagnoses obtained for those who died in a district hospital; and calculation of sensitivity, specificity and positive predictive value (PPV) for children under 5 years, and adults 15 years and older. RESULTS: A total of 127 hospital diagnoses satisfied the criteria for inclusion as reference diagnoses. For communicable diseases, sensitivity of VA diagnoses among children was 69%, specificity 96%, and PPV 90%; among adults the values were 89, 93 and 76%. Lower values were found for non-communicable diseases: 75, 91 and 86% among children; and 64, 50 and 80% among adults. Most misclassification occurred within the category itself. For deaths due to accidents or violence, sensitivity was 100%, specificity 97%, and PPV 80% among children; and 75, 98 and 60% among adults. Since causes of death were largely age-specific, few differences in sensitivity, specificity and PPV were found for adults and children. The frequency distribution of causes of death based on VAs closely approximated that of the hospital records used for validation. CONCLUSION: VA findings need to be validated before they can be applied to district health planning. In Agincourt, a single verbal autopsy instrument provided a reasonable estimate of the frequency of causes of death among adults and children. Findings can be reliably used to inform local health planning and evaluation.

Adolescent↗
PubMed1999

Reversal in mortality trends: evidence from the Agincourt field site, South Africa, 1992-1995.

OBJECTIVE: To examine changes in mortality in rural South Africa over the period 1992-1995 by age, sex and cause of death. DESIGN: As with much of sub-Saharan Africa, South Africa lacks effective vital registration and information on mortality is lacking. The Agincourt demographic and health surveillance system was established to inform health policy and practice with regard to rural subdistrict populations. METHODS: Prospective community-based study involving annual update of a household census with enquiry into all birth, death and migration events. All reported deaths (n = 1001) are the subject of a verbal autopsy. RESULTS: An increasing trend in overall mortality relative to general population growth in the study area is apparent. There is evidence for a reversal in the previously declining trend in mortality among women 20-44 years. A comparison of 1992-1993 with 1994-1995 shows that most of the increase in mortality is concentrated in the younger adult (20-49 year) age group. AIDS and related diseases, particularly tuberculosis, appear primarily responsible. Injuries and violence (especially homicide) and circulatory disease are important, under-recognized causes of death, although their levels have remained constant over the period. CONCLUSIONS: Mortality from AIDS and related diseases appears responsible for the probable reversal in mortality emerging in South Africa's rural northeast. Findings carry implications for the emerging system of decentralized health care.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Who dies from what? Determining cause of death in South Africa's rural north-east.

Information on cause of death is essential for rational public health planning, yet mortality data in South Africa is limited. In the Agincourt subdistrict, verbal autopsies (VA) have been used to determine cause of death. A VA is conducted on all deaths recorded during annual demographic and health surveillance. Trained lay fieldworkers interview a close caregiver to elicit signs and symptoms of the terminal illness. Each questionnaire is reviewed by three medical practitioners blind to each other's assessment, who assign a 'probable cause of death' where possible. Of 1001 deaths of adults and children identified between 1992 and 1995, 932 VAs were completed. The profile of deaths reflects a mixed picture: the 'unfinished agenda' of communicable disease and malnutrition (diarrhoea and kwashiorkor predominantly) are responsible for over half of deaths in under-fives, accidents are prominent in the 5-14 age-group, while the 'emerging agenda' of violence and chronic degenerative disease (particularly circulatory disease) is pronounced among the middle-aged and elderly. This profile shows the social and demographic transition to be well underway within a rural, underdeveloped population. Validation of VA findings demonstrate that the cause of death profile derived from VA can be used with confidence for planning purposes. Findings of note include the high death rates from kwashiorkor and violence, emerging AIDS and pulmonary tuberculosis, and circulatory deaths in the middle-aged and young elderly. A deeper understanding of the causal factors underlying these critical health problems is needed to strengthen policy and better target interventions.

Accidents↗
PubMed1999

The Agincourt demographic and health study--site description, baseline findings and implications.

OBJECTIVES: To present baseline results from first-phase demographic and health surveillance in the Agincourt field site, Bushbuckridge. To contrast findings with international data, and comment on their relevance to health development. DESIGN: Multi-round, prospective community-based study. Baseline census, 1992. SETTING: A subdistrict in South Africa's rural north-east, adjacent to the border with Mozambique. SUBJECTS: Entire population of the Agincourt subdistrict. OUTCOME MEASURES: Baseline variables for each resident included age, sex, months spent at home during 1991, mother alive/dead, highest educational standard achieved, and refugee status. A full demographic profile was constructed. RESULTS: In 1992 the subdistrict contained 57,609 persons, 26.4% of whom were Mozambican, with a population density of 148 persons per km2. Forty-four per cent were under 15 years of age, and the dependency ratio was 93%. Fertility was declining, along with a moderate decline in adult female mortality. The approximate total fertility rate was 4.0; teenage parenting was common and almost 40% of 19-year-olds had at least one child. Over 60% of men and 14% of women in the 30-49-year age group were migrants, resulting in a high proportion of single-parent households. Despite improvements, most children experienced delays in reaching primary school, and less than half made the transition to secondary school. Educational levels among Mozambican children were lower than those of local children. CONCLUSIONS: Agincourt contains a complex mix of communities comprising migrant workers, Mozambicans and a more stable permanent population. The area shares features with sub-Saharan Africa, although the mortality and fertility transitions have progressed further. Reliable, local information is essential for managing decentralised health systems.

Adult↗
PubMed1992

Protein energy malnutrition and its recognition in outpatient departments in Venda hospitals.

Between April and June 1988 the number of children under 5 years old attending outpatient departments of Venda hospitals who had protein energy malnutrition (PEM) was determined, the proportions at 3 Venda hospitals were compared, and what percentage of these children was detected by attendant health workers was determined. Approximately 6% had severe PEM; this finding was consistent for all 3 hospitals. The rates for mild PEM were 22% for Tshilidzini and Donald Fraser Hospitals and 33% for Siloam Hospital. This statistically significant difference has not been explained. Health workers failed to recognise about 25% of children with severe PEM and 50% of children with mild PEM. It is suggested that certain interventions and activities are essential if PEM is to be adequately managed: these are efficient monitoring; pre-employment and in-service education for health workers; a breast-feeding and weaning survey; and an investigation of the variation of malnutrition among Venda hospitals.

Child, Preschool↗
PubMed1992

Child health in farm workers' communities.

Black women who had borne one or more children in the 5 years preceding the study and who were resident on white-owned farms were sampled in a multistage cluster procedure from the population of two magisterial districts of the southern Transvaal, Ventersdorp and Balfour. The purpose of this study was to determine mothers' knowledge and behaviour regarding the health of their children, to correlate this with personal and social characteristics of the mothers, and to document aspects of their physical environment. Only 50% of mothers had completed 4 or more years of formal education. One in three had experienced the death of at least 1 of her children. Water and sanitation facilities were inadequate for most. Little was known about oral rehydration solution preparation or about growth monitoring. Most children were breast-fed. Between 50% and 63% of the children had vaccinations appropriate for their ages, depending on whether evidence from clinic cards or from mothers' memories was taken as valid. The single most important determinant of the appropriate knowledge and behaviour of mothers was education. Basic living and social conditions of farm workers require improvement and the health services must be re-orientated to deliver comprehensive primary care.

Black or African American↗
PubMed1991

Botshabelo's vaccination survey.

This community-based survey evaluates vaccination coverage of small children and socio-economic status of their households in a randomly selected sample of a black South African township. It reveals a poverty-stricken community, where only 19% of the children surveyed were fully vaccinated. It is suggested that expansion of health infrastructures together with a co-ordinated strategy of immunisation would result in a spectacular increase in vaccination coverage.

Diphtheria Toxoid↗
PubMed1991

Reproductive health care in the Gelukspan Health Ward.

Reproductive health care, namely family planning, antenatal care (ANC), labour care and postnatal care, was studied in the Gelukspan health ward of Bophuthatswana in 1985-1986. Only a minority of the women interviewed (20%) had planned their last pregnancy, but most had attended for ANC (93%) and had had supervised deliveries in a hospital or clinic (80%). Most (97%) knew of modern methods of fertility control but only a minority (37%) were using them. Planned pregnancies were more likely to be reported by married women (73% of 37 v. 9% of 173; P = 0.0000) who left school at an earlier age (16.0 +/- 5.9 years v. 17.0 +/- 3.9 years; P = 0.0462). If unmarried, women who had planned their pregnancy were more likely to be maintained by the father of the child (15% v. 4%; P = 0.0134). They were also less likely to have left school because of the pregnancy (20% v. 50%; P = 0.0001). Unmarried women with supervised deliveries are more likely to have financial support from the father of the child. Maternal school education is positively related to attendance for ANC, attendance for supervised labour and utilisation of modern methods of fertility control. There seems to be an intricate relationship between the different outcomes measured. ANC attenders were more likely to have supervised deliveries. Both groups were more likely to start attending for child health care earlier and more frequently. Our results are discussed.

Family Planning Services↗
PubMed1991

Early life nutrition in the Gelukspan Health Ward.

Breast-feeding, supplementary feeding and weaning practices as well as nutrition during the second year of life were studied in 210 black primiparas, who had cared for their own children through the first year, in a poor, one-crop (maize) rural area in Bophuthatswana. The sampling strategy was similar to the one recommended by UNICEF for assessment of vaccination coverage. Only 1 child had never been breast-fed and 60% were still breast-fed at the time of the interview during the second year of life. A number of factors were detected that seem important determinants of breast-feeding behaviour, e.g. marital status and level of formal education. Early supplementary feeding and early weaning were identified as major problems. Children were weaned onto commercial feeds or low-energy-dense staples, and there was also an obvious lack of energy-dense foods (e.g. butter, coconut oil) during the second year of life. Some determinants of these practices were recorded. The data have implications for the health services and should influence social and educational policy for the area. If properly implemented, the recommendations could result in significant financial saving for the study population. The health services should promote appropriate nutritional education, starting with antenatal care, early and frequent attendance at child health services should be encouraged and education concerning nutrition should be strengthened, and health education should encourage prolonged breast-feeding, discourage the use of commercial weaning foods, and encourage the use of natural multimixes (e.g. bananas, beans, cooking oil) for weaning. The importance of energy-dense foods should be emphasised to mothers and to health workers.

Adult↗
PubMed1991

Child health and childminding.

With the objective of determining whether training childminders could improve the health of the children in their care, a controlled trial was conducted among volunteer childminders in a white working-class community in Johannesburg. A small sample of non-volunteer childminders studied did not differ significantly from the minders who did volunteer to participate in the study, except in that they claimed to have more difficulty in attending the training course. The results show that demographic features and scores for the trainee and control groups did not differ significantly before training. After training there were improvements in 4 of the 5 measured scores for the trainee group as opposed to the control group, namely the number of physically detected medical problems, the children's immunisation status, the physical and emotional environment provided by the childminders, and the childminders' knowledge of first aid. The medium-term findings of this study show that training childminders is worthwhile in this community.

Child↗
PubMed1991

Measuring environmental health status in Oukasie, 1987.

This article reports on some aspects of the physical environment and on environmental health services at Oukasie. The data were collected over a weekend in August 1987 by an interview and by direct inspection of the environment using a standard schedule. We had a 100% response rate on the interviews. There was a mean of 2.2 +/- 1.6 persons per room in the households, with brick houses being less crowded than non-brick houses. Private yards were generally kept very clean. Bucket latrines were unhygienic and used by an average of 4 families. No latrine was built to accepted standards. Garbage collection and emptying of the bucket latrines by the municipality seemed to be unsatisfactory. Our overall impression was that where responsibility for maintenance of hygiene is either undefined, such as the collection chambers of bucket latrines, or a responsibility of the public authorities, such as garbage collection and water drainage, there is an unsatisfactory state of hygiene. Where maintenance of cleanliness is clearly a private responsibility, such as the maintenance of the cleanliness of private yards, the general status of hygiene is good.

Black or African American↗
PubMed1991

Community health survey of Oukasie, 1987.

A series of surveys were conducted at the request of the community of Oukasie to determine certain public health information in the township, a peri-urban black community. This article describes two of these surveys. The first, a census and partial demographic survey, showed that the total black population was around 6,300 with a mean household occupancy of 4.1. Some of the estimated vital statistics calculated were an infant mortality rate of 36.6/1,000, a crude birth rate of 28.0/1,000, a crude death rate of 6.5/1,000, and a general fertility rate of 99.3/1,000. The second survey into the nutritional and immunisation status of children aged under 5 years showed that 20% of children were underweight and nearly half were incompletely immunised at 1 year of age. These studies, involving local community and student volunteers, were rapidly and inexpensively done and provide basic public health information.

Adolescent↗
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

Diarrhoeal diseases and oral fluid therapy in the Gelukspan health ward.

This study reports the results on diarrhoeal disease and oral fluid therapy (OFT) obtained during a survey on maternal knowledge and child health in the Gelukspan health ward (GHW) in 1985-1986. We studied 210 women sampled by means of a multistage sampling procedure. Strict selection criteria ensured that the baby had been born in the GHW, that it was the first-born and the only child, and that it had been cared for by the mother from birth until the time of interviewing. All the children were between 12 and 24 months old. Information was collected by interviewing the mother and by analysing data on the home-retained 'Road to Health' cards (RTHCs) of the study children. Ninety-three per cent of the children had an RTHC and 97% of these had at least one record about reasons to visit the health service. Most visits were 'well' visits (71%), 18% were associated with respiratory tract complaints, and 12% were associated with gastro-intestinal complaints (most commonly diarrhoea). Sixty-three per cent of children with data on visits to the health services attended at least once with gastro-intestinal complaints during the first year of life. About two-thirds of the mothers knew the composition of an acceptable oral fluid solution for home therapy of diarrhoeal disease. Only 40% knew how frequently it should be given and only a quarter knew how much to give. After multivariate analysis the only independent variables that remained predictors of knowledge on OFT were maternal knowledge on signs and symptoms of dehydration (SSD) and frequency of gastro-intestinal complaints as recorded on the RTHC.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-Sectional Studies↗
PubMed1989

Health authorities' support for crèches.

A study was undertaken to determine the extent of crèche services in rural areas of southern Africa, the level of support from the health authorities and their understanding of the function of and legislation pertaining to crèches in the light of the explosive expansion of preschool child-care services in both rural and urban areas. One hundred hospitals, serving mostly rural health wards, were surveyed using a postal questionnaire and the response rate was 85%. Sixty hospitals reported that crèches were in existence in their health wards and 45 claimed to be providing health care on a regular basis. Forty-one respondents were completely unaware of legislation regulating crèche services and most of the remaining 19 misquoted the legislation. Most respondents perceived the role of the crèche as providing a place of safety for the children of working parents but only 21 identified education as an important crèche function. It is concluded that there is a lack of awareness of the role of crèches in rural areas and also inadequate support for crèche services.

Child Health Services↗
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↗