A community-based sero-epidemiological survey was undertaken to determine the age-specific prevalence rates of hepatitis A virus (HAV) infection in a representative sample of 782 urban black children aged from newborn to 13 years. Among children aged 0-5 months, the prevalence of anti-HAV was 68.8% (95% confidence interval (CI) 60.6-77.0%); this fell to a low of 2.5% (CI 0.1-4.9%) in those aged 6-11 months, implying the presence of maternal antibody in the first few months of life. By the age of 2 years, 51.2% (CI 45.7-56.7%) had anti-HAV, by age 4 the prevalence had risen to 81.4% (CI 75.5-87.3%) and by age 6, the prevalence of anti-HAV was almost 100% (CI 90.5-96.7%), reflecting the poor socio-economic and environmental conditions these children live in. The lowest prevalence of HAV infection among urban black South African children was during infancy, before the age at which the incidence rate rose sharply; e.g. 1 out of 5 children was already infected with HAV by its 2nd birthday. Vaccination in infancy will therefore have the biggest impact on the spread of HAV. However, before HAV vaccination in infancy is advocated, vaccine immunogenicity in infancy and the possible detrimental effect of maternal antibodies on the immunogenicity of the vaccine need clarification.

Black or African American↗

PubMed1993

Unsustainability of a measles immunisation campaign--rise in measles incidence within 2 years of the campaign.

The 1990 national mass measles immunisation campaign resulted in a marked reduction in measles incidence in Natal/KwaZulu in the first 6 months after the campaign. Data from the measles ward admissions book at Clairwood Hospital were collated for the period 1 January 1989 to 31 May 1992 to assess the sustainability of the effects of the campaign. For the first 12 months after the campaign, measles admissions were consistently low. Thereafter, the number increased steadily, rising sharply to above pre-campaign levels 21 months after the campaign. The age distribution of measles patients indicated that the initial fall in the 10-12-month age group had been reversed in the second year after the campaign, suggesting that the high vaccination coverage achieved for this age group during the campaign had not been maintained. Measles admissions to Clairwood Hospital indicate that the effect of the measles immunisation campaign has not been sustained and that urgent action is required to avert a possible epidemic.

Child↗

PubMed1993

Traditional healers and AIDS prevention.

A qualitative case study of the views and experiences of an isangoma was undertaken to explore potential preventive health roles that traditional healers could play with regard to the AIDS epidemic. The isangoma's knowledge of the transmission mechanisms, risk groups and prevention strategies for AIDS was accurate. Her questionable beliefs included a Nazi conspiracy as the source of AIDS, a string ritual to prevent promiscuity and a conviction that she could treat AIDS. Notwithstanding the latter beliefs, her generally factual knowledge of AIDS indicated that she could be an important source of AIDS information in the community; she was, in fact, already providing some AIDS counselling. Considering their large clientele, established preventive health ethic, extensive distribution in rural areas and potential ability to influence the contextual factors that affect risk-reducing behaviours (e.g. condom use), it is recommended that traditional healers be incorporated into AIDS prevention programmes where they can play a role in community-based AIDS education and condom promotion.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Academic health complexes--ivory towers or national resources?

Explore the source record for details and available documents.

Academic Medical Centers↗

PubMed1993

Hepatitis C virus infection in urban and rural Natal/KwaZulu.

This study was undertaken to estimate the prevalence of hepatitis C virus (HCV) infection in urban and rural blacks in Natal/KwaZulu. Sera from representative community-based samples comprising 176 urban and 441 rural black adults were tested for the presence of anti-HCV. The prevalence of HCV infection was 1.7% (95% confidence interval 0-3.6%) among urban and 0.9% (95% confidence interval 0.1-1.7%) among rural blacks. Four (0.9%) of the 466 subjects with evidence of current or past hepatitis B virus (HBV) infection and 3 (2%) of the 151 with no evidence of HBV infection were anti-HCV-positive. The prevalence of HCV infection was low in contrast to the high prevalence of HBV infection among urban and rural blacks in Natal/KwaZulu. This suggests that HCV does not have the same main routes of transmission as HBV in this region. Larger scale studies are needed to explore this hypothesis.

Adult↗

PubMed1992

Seroprevalence of HIV infection in rural South Africa.

OBJECTIVES: To establish the prevalence of HIV infection in rural South Africa and to investigate demographic factors that influence this prevalence. DESIGN: An anonymous HIV seroprevalence survey was performed in conjunction with a population-based malaria surveillance programme. SETTING: The rural area of northern Natal/KwaZulu, South Africa. PARTICIPANTS: A total of 5023 black African participants were recruited by malaria surveillance agents during house-to-house visits; each house in an endemic malaria area is visited approximately once every 6 weeks. Participants included 4044 healthy and 979 febrile individuals (i.e., suspected of having malaria). MAIN OUTCOME MEASURES: HIV-1 and HIV-2 serological status, degree of mobility, age and sex. RESULTS: Sixty of the 5023 blood specimens were confirmed to be HIV-1-antibody-positive by Western blot, an overall prevalence of 1.2% (95% confidence interval, 0.9-1.5). None of the specimens was positive for HIV-2 antibodies. After adjusting for age, presence of fever and migrancy, women had a 3.2-fold higher prevalence of HIV-1 infection than men. HIV-1 infection was approximately three times more common among subjects who had changed their place of residence recently (2.9 versus 1.0%, P < 0.01). CONCLUSIONS: The prevalence of HIV-1 infection is higher among women than men resident in rural Natal/KwaZulu, South Africa. This is at least in part the result of oscillatory migration, particularly of men who work in urban areas but have families and homes in rural areas. Migration is associated with a higher prevalence of HIV-1 infection, suggesting that improving social conditions so that families are not separated and become settled in their communities is one way to help reduce the spread of HIV-1.

Adolescent↗

PubMed1992

Teenagers seeking condoms at family planning services. Part I. A user's perspective.

The promotion of condom use is an essential part of any AIDS prevention programme. By distributing condoms and promoting their use, clinics that provide family planning services can play an important role in preventing the spread of AIDS. This study assesses the accessibility of condoms to teenagers at selected family planning services in Durban. Twelve randomly selected clinics in Durban were visited by each of 4 teenage fieldworkers. During these visits, the fieldworkers' experiences were recorded in detailed notes which were subsequently analysed for content. The fieldworkers experienced difficulty in locating a few of the clinics and some were embarrassed by security staff. The two female fieldworkers, in particular, were intimidated by their reception at the clinics and found resistance to their requests for condoms. On two occasions, supplies of condoms had run out. When condoms were available, they were distributed in a setting that lacked privacy. Information on how to use condoms, if offered at all, was supplied by way of pamphlets and information on AIDS was rarely offered. Overall, the experiences of the fieldworkers indicated that it was difficult for teenagers to obtain condoms from clinics providing family planning services in Durban. It is recommended that there be signs indicating the location of the clinics, and that privacy be ensured and adequate stocks of condoms maintained. Most importantly, clinic staff need to use every opportunity to discuss AIDS prevention with teenagers attending the clinic.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Teenagers seeking condoms at family planning services. Part II. A provider's perspective.

This study assessed the ability and preparedness of staff at family planning clinics in Durban to assist in AIDS prevention by promoting condom use among teenagers. Staff at 12 randomly selected clinics were interviewed to assess their attitudes towards teenagers seeking condoms, the information imparted on AIDS and condom use, constraints faced in delivering services, and their perceived role in controlling the spread of AIDS. Despite their awareness of AIDS, those interviewed perceived their role to be that of promoting contraception. Condoms were perceived as a poor choice of contraceptive and their use was discouraged. The pamphlets dispensed along with condoms were thought to provide adequate information about condom use. Information on AIDS was given only if the clinic attender initiated discussion on the subject. Most of the clinic staff were keen to discuss other issues during their consultations, but felt constrained by the large numbers of people they had to attend to and the lack of adequate facilities. If family planning services are to play a role in controlling the spread of AIDS, the first step must be to make this function part of the overall policy. For there to be effective counselling on AIDS prevention, in-service training of current staff is required, as well as more staff and improvements in facilities to ensure greater privacy.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Changes in HIV seroprevalence in a rural black community in KwaZulu.

Explore the source record for details and available documents.

Adult↗

PubMed1992

Reasons for lack of condom use among high school students.

This exploratory qualitative study was undertaken to identify barriers to condom use among high school students in Natal. Phase 1, a group discussion, with 50 high school students of all races from 10 schools, revealed that 17 (34%) were sexually active, 8 (47%) of these had used a condom at least once, but none had used condoms in every sexual encounter. Phase 2 comprised 36 focus group discussions involving about 650 black high school students. These discussions confirmed the finding of phase 1 that high school students were not using condoms to any significant degree. In their opinion, condoms limited sexual pleasure, indicated a lack of trust in the partner's faithfulness, challenged the male ego, and were associated with sexually transmitted diseases. Their contraceptive properties were viewed with suspicion and considered undesirable by those teenagers who wished to prove their fertility. In addition, condom use was not sufficiently well understood and condoms were not accessible or available when required. We recommend that condom promotion strategies should include an adequate explanation of how condoms work and detailed information on their local availability. They should be available at a government-subsidised price through more accessible outlets; popular figures and recognised leaders should be encouraged to support anti-AIDS campaigns and condom use, particularly in the public media.

Adolescent↗

PubMed1991

Impact of a measles immunisation campaign on measles admissions to a Natal hospital.

During May and June 1990, a national mass measles immunisation campaign was undertaken in South Africa. This study is an assessment of the impact of the campaign on measles admissions to a provincial referral hospital that has specifically designated wards for children with communicable diseases. Data from the measles ward admissions book for the 18 months before the campaign (1 January 1989-30 June 1990) and 6 months after the campaign (1 July 1990-31 December 1990) were compared. Since the campaign, the average number of measles admissions has declined by 64.4% from 87 to 31 per month (P less than 0.01). Before the campaign, 21.3% of measles patients admitted were aged 7-9 months compared with 27.6% after the campaign, highlighting the urgent need to improve the measles vaccination coverage in this age group. An analysis of the geographical source of patients showed that measles continued to occur after the campaign in most of the areas where it existed before the campaign. It is concluded that important gains have been achieved by the campaign. These will be rapidly eroded and epidemics of measles may occur if measles vaccination efforts wane and slump back to pre-campaign levels. It is important to capitalise on the momentum generated through the campaign by continuing to support efforts of existing health care services to improve and maintain high levels of measles immunisation coverage.

Child↗

PubMed1991

Sexual behaviour and knowledge of AIDS among urban black mothers. Implications for AIDS intervention programmes.

Questionnaires were administered to 122 urban black mothers of teenagers in order to: (i) understand aspects of their sexual behaviour and knowledge of the acquired immunodeficiency syndrome (AIDS); and (ii) assess their communication with their teenage children with regard to AIDS and sexual behaviour. The subjects comprised a 12.5% random sample of all houses in Lamontville, a black township south of Durban. The level of AIDS knowledge among mothers was high, while their sexual behaviour, characterised by a high pregnancy rate and a high proportion who have had children by more than one consort, placed them at high risk of acquiring human immunodeficiency virus (HIV) infection. No mother had experienced sexual intercourse during which her partner used a condom. Communication with their teenage children was poor; none of the mothers had spoken with them about AIDS and 89.3% had not discussed contraceptive methods with their teenage children. We found that urban black mothers were at high risk of acquiring HIV and, despite their knowledge of the modes of transmission and prevention of HIV infection, they had not begun using condoms as a risk-reducing measure, nor had they communicated the risk of unprotected sex to their teenage children. We recommend that AIDS intervention strategies should not concentrate only on passing on knowledge but also on providing women with the communication skills to negotiate the use of condoms with their partners and to convey the risk of HIV infection to their teenage children.

Acquired Immunodeficiency Syndrome↗