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PubMed1996

[The halofantrine treatment of Plasmodium falciparum malaria. Clinical experience].

UNLABELLED: The objective of this study was to evaluate the efficacy of halofantrine in the treatment of malaria caused by Plasmodium falciparum since the resistance of these plasmodium to chloroquine is increasing in countries of Western Africa. MATERIAL AND METHOD: Between January 1991 and June 1994 we studied 50 children from Equatorial Guinea. All of them were black and between the ages of 8 months and 13 years. They were treated with 3 doses of halofantrine (8 mg/kg every 6 hours). The definitive diagnosis was made by the demonstration of the parasites on thick and thin blood smears, stained by standard methods, repeated every 24-72 yours after therapy. We considered the disappearance of fever and the clearance of plasmodium from the red blood cells as signs of response to the treatment. We also monitored the tolerance and the adverse side effects of the drug. RESULTS: All of the patients responded favorably with the disappearance of the fever after 24 hours and after 72 hours no parasites were seen in red blood cells. Only one patient had a recurrence, which occurred on the 10th day. All patient satisfactorily tolerated the drug and only 3 children showed an increase of aminotransferases that was spontaneously cured. CONCLUSIONS: We conclude that halofantrine is a safe and efficient drug for the treatment of children diagnosed with malaria caused by Plasmodium falciparum.

Adolescent↗
PubMed1997

Human monkeypox--Kasai Oriental, Zaire, 1996-1997.

Monkeypox is an orthopoxvirus with enzootic circulation in rainforests of central and western Africa; the virus can be transmitted to humans and cause a syndrome clinically similar to smallpox (e.g., pustular rash, fever, respiratory symptoms, and in some cases, death). From February through August 1996, a total of 71 clinical cases of monkeypox, including six deaths, occurred in 13 villages in Africa in the Katako-Kombe health zone (1996 combined population: 15,698), Sankuru subregion, Kasai Oriental, Zaire. During the initial investigation of this cluster of human cases, specimens of serum and/or crusted scab or fluid from vesicles were collected from 11 patients, and monkeypox virus infection was confirmed in all 11 patients by the World Health Organization (WHO) Collaborating Center for Smallpox and Other Poxvirus Infections at CDC. Preliminary DNA phylogenetic studies of this strain of virus indicated only minor genetic variation compared with other strains of monkeypox virus from Zaire collected during 1970-1979. Because of reports by local public health officials of ongoing disease transmission, the Zaire Ministry of Health and WHO organized a follow-up investigation in February 1997 to characterize the magnitude of the outbreak. This report summarizes the preliminary results of the ongoing multidisciplinary investigation, which suggest that person-to-person transmission accounted for most monkeypox cases investigated in 1996 and 1997; in contrast, during previous years, reports were primarily for sporadic cases that resulted from animal-to-human transmission.

Cluster Analysis↗
PubMedDate not supplied

[Impact of changes in the environment on vector-transmitted diseases].

We have defined the relationship between infectious diseases and environmental conditions and considered the development of this relationship to its current situation, where human intervention is occurring more often and is becoming more aggressive. The increase in the transport of freight and passengers by air has allowed parasite vectors to spread quickly and easily over large distances. Every country can now be reached from any other country within a couple of days. Usually, foreign species are unable to establish themselves and to persist in the new environment; but the recent arrival of Aedes albopictus in Albania, Italy and the Americas is a cause for concern. Demographic pressure has increased the need for land and the exploitation of new areas leads to large changes in the vegetation. The classic example of this man-made damage is the destruction of tropical forest in Western Africa, but the destruction of herbaceous vegetation, such as papyrus, in East Africa, could also have serious epidemiological consequences. Streams and rivers have been managed for power production and irrigation. The use of dams, both large and small, and the culture of rice in paddy-fields produces large expanses of water which are suitable breeding grounds for mosquitoes and snails, the vectors of human diseases such as malaria and schistosomiasis in sub-Saharan Africa. They are, however, of lesser importance in Asia and the Americas. Urbanization imposes a set of very similar structures on a specific rural environment. The effect of these two factors on each other determines the pathologies associated with each town. The suburban area is a specific environment where both urban and rural diseases occur and are made worse by poor hygiene conditions (waste, sewage, etc.). However, not all man-made changes to the environment cause a deterioration in public health. Urban and agricultural development projects must consider these issues and should use medical and environmental studies to avoid causing epidemic-prone conditions or spreading endemic diseases. Currently, most studies are limited to listing the specific diseases in the target area and very few attempt to assess the possible consequences of changing the environment. Forecasting the consequences of changes in environmental management is of great importance, but it requires the development of multi-disciplinary teams in the field who must be involved in the planning and implementation of the projects.

Aedes↗
PubMed2005

The impact of organophosphate pesticides in orchards on earthworms in the Western Cape, South Africa.

Earthworm population density was measured in and adjacent to an orchard in an agricultural area in the Western Cape, South Africa. Worm densities were very low in orchards (22/m(2)) compared to adjacent uncultivated fields (152/m(2)) at a distance from the orchards. The possible effect of organophosphate pesticides on the earthworms was investigated. Background soil concentrations of chlorpyrifos prior to the start of the spraying season were low (0.2-2.7 microg/kg) but persistent for up to 6 months after the last spraying event, and the pesticide was, as a result of rainfall, transported to nontarget areas by runoff. Background concentrations of azinphos methyl were higher than those of chlorpyrifos (1.6-9.8 microg/kg) but not detectable 2 weeks after a spraying event. Azinphos methyl was mostly transported by wind (spray drift) to adjacent areas. A microcosm study indicated effects of chlorpyrifos on earthworms as determined by measuring biomass change and Cholinesterase inhibition. It is concluded that earthworms were affected detrimentally by the pesticides due to chronic (chlorpyrifos) and intermittent (azinphos methyl) exposure.

Agriculture↗
PubMed2006

The hearing profile among learners in schools in the Western Cape, South Africa.

The hearing profile amongst school learners in the Western Cape was investigated. The University of Cape Town's hearing-screening programme at 11 primary schools (n=1101) was audited and revealed a 13.8% referral rate amongst school-aged children. The possible effects of environmental noise on hearing-screening performance at 500Hz was investigated. When the hearing-screening results at 500Hz were excluded from the audit, the referral rate was reduced from 13.8% to 7.9%. The referral rate for hearing-screening failures amongst the learners in the sample was towards the high end of the range for developing countries (3.3-13.9%). More learners had unilateral than bilateral hearing failures while laterality, gender and geographical differences were minimal. This high referral rate suggests a strong need for hearing-screening of the school-aged population.

Audiometry↗
PubMed1998

The molecular basis of C6 deficiency in the western Cape, South Africa.

Deficiency of the sixth component of human complement (C6) has been reported in a number of families from the western Cape, South Africa. Meningococcal disease is endemic in the Cape and almost all pedigrees of total C6 deficiency (C6Q0) have been ascertained because of recurrent disease. We have sequenced the expressed exons of the C6 gene from selected cases and have found three molecular defects leading to total deficiency: 879delG, which is the common defect in the Cape and hitherto unreported, and 1195delC and 1936delG, which have been previously reported in African-Americans. We also show that the 879delG and 1195delC defects are associated with characteristic C6/C7 region DNA marker haplotypes, although small variations were observed. The 1936delG defect was observed only once in the Cape, but its associated haplotype could be deduced. The data from the haplotypes indicate that these three molecular defects account for the defects in all the 38 unrelated C6Q0 individuals we have studied from the Cape. We have also observed the 879delG defect in two Dutch C6-deficient kindreds, but the 879delG defect in the Cape probably did not come from The Netherlands.

Base Sequence↗
PubMed1999

Optimization of phenytoin therapy in adults with epilepsy in the Western Cape, South Africa.

OBJECTIVE: To assess the extent to which adults with epilepsy were optimized and individualized on phenytoin monotherapy in the Western Cape, South Africa and to estimate the average optimized dose and serum phenytoin concentration, and the therapeutic range for this patient group. METHODS: Patients were considered to be optimized on phenytoin if they were seizure-free or the best compromise was achieved between seizure reduction and side-effects. RESULTS: 538 (233 black and 305 coloured) adult people with epilepsy were treated at nine epilepsy clinics as outpatients. Of these patients, 332 (226 male and 106 female, 149 black and 183 coloured) were included in the data analysis as they were considered to have reliable phenytoin levels. Phenytoin doses and steady-state serum concentrations were predicted using the Michaelis-Menten equation. Patients attended a clinical pharmacokinetic service for 7.7+/-5.3 (range 1-22) months. The average optimized dose was 305.8 (range 100-500) mg/day and the average optimized level was 62.7+/-23.9 (range 15-133) micromol/l. Most patients (61.9%) were optimized in the therapeutic range 40-79 micromol/l; 21.1% were optimized above and 17% below this range. In 1.6% of patients serum concentrations above 120 micromol/l were required. Dosage adjustments were made in 47.0% of patients, increased in 31.9% and reduced in 15.1%. CONCLUSION: These findings indicate that many patients (47%) attending outpatient clinics were not optimized on phenytoin therapy.

Adolescent↗
PubMed2006

Kribbella karoonensis sp. nov. and Kribbella swartbergensis sp. nov., isolated from soil from the Western Cape, South Africa.

Two novel nocardioform actinomycetes, strains Q41T and HMC25T, were isolated from soil samples collected in the Western Cape province, South Africa. Rapid genus identification revealed that the isolates belonged to the genus Kribbella (based on single-digestion restriction analysis of the 16S rRNA gene sequences with MboI, VspI, SphI, SnaBI, SalI and AgeI). Both isolates had ll-diaminopimelic acid and glycine in their cell-wall peptidoglycan, and contained mannose and ribose as whole-cell sugars. Strain HMC25T is able to grow at 45 degrees C and in the presence of NaCl (3 %), cephaloridine (10 microg ml(-1)) and gentamicin sulphate (10 microg ml(-1)). Strain Q41T grows in the presence of NaCl (2 %). Neither strain was able to grow under anaerobic conditions, whereas Kribbella flavida KACC 20248T, Kribbella jejuensis HD9T, Kribbella koreensis KACC 20250T and Kribbella sandramycini KACC 20249T exhibited weak but distinct growth under anaerobic conditions. Physiological test results and 16S rRNA gene sequence analysis allowed Q41T and HMC25T to be distinguished from other members of the genus with validly published names. Strains HMC25T (=NRRL B-24426T=DSM 17345T) and Q41T (=NRRL B-24425T=DSM 17344T) therefore represent the type strains of novel species, for which the names Kribbella swartbergensis sp. nov. and Kribbella karoonensis sp. nov., respectively, are proposed.

Actinomycetales↗
PubMed2003

Regional status, epidemiology and impact of Taenia solium cysticercosis in Western and Central Africa.

In West Africa, Taenia solium cysticercosis in both pigs and man has been reported in Benin, Burkina-Faso, Ghana, Ivory Coast, Senegal and Togo, and although official data are lacking, T. solium is anticipated to be present in most of the pig-raising regions of other West African countries as well. In some regions of Nigeria, the prevalence of porcine cysticercosis and human taeniosis is quite high (20.5 and 8.6%, respectively). Surprisingly, however, no cases of human cysticercosis have been reported, although epilepsy is very common. Large epidemiological surveys have only been carried out in Togo and Benin, where the prevalence of human cysticercosis was 2.4 and 1.3%, respectively. In Central Africa, porcine and human cysticercosis are (hyper)-endemic in Rwanda, Burundi, the Democratic Republic of Congo and Cameroon. The parasite also has been reported in pigs in Chad and Angola. Cysticercosis has been shown to be one of the major causes of epilepsy in Cameroon with figures as high as 44.6%. Cameroon is one of the few countries where the taeniosis-cysticercosis complex has been examined more in detail. In the Western province of Cameroon large scale surveys have shown that active cysticercosis is present in 0.4-3% of the local population and in 11% of the village pigs. However, the prevalence of adult T. solium was only 0.1%, which underscores the frequency of the T. solium paradox. Based on the available information, a very conservative economic estimate indicates that the annual losses due to porcine cysticercosis in 10 West and Central African countries amount to about 25 million Euro. The financial losses due to human cysticercosis are very difficult to estimate, but are certainly exceeded by the social impact of the disease, especially because of the particular perception of epilepsy in many African communities. It is concluded that the true prevalence of T. solium cysticercosis in pigs and humans in Central and West Africa remains underestimated because of unreliable slaughterhouse data and the lack of awareness and diagnostic facilities in the public health sector.

Abattoirs↗
PubMed2004

Incidence and patterns of childhood burn injuries in the Western Cape, South Africa.

The current study describes the epidemiology and patterns of moderate to severe childhood burn injuries in the Western Cape province in South Africa. Burn injuries sustained by children aged 12 years and younger and registered over January 1999 to December 2000 at the Red Cross Children's Hospital in the Western Cape are analysed (n=1201). Differences in risk distribution between different segments of the population are measured and typical injury patterns are identified. The results show that burn injury incidence is particularly high for toddlers (15.8/10000 child-years/c-y) and infants (14.6/10000 c-y) for boys (7.0/10000 c-y), and for African children (11.4/10000 c-y). Burn injury incidence is highest in winter (1.7/10000 c-y) but only significantly greater than the rate in summer (1.3/10000 c-y). Further, four burn injury patterns are identified, and labeled 'infant scalding', 'toddler scalding', 'injuries among older children with an over-representation of flame-related burns' and 'other causes of burns sustained to the head and neck region'. In sum, the risk of burn injury is higher in younger children. Differences between genders were more pronounced among younger and older age groups. Differences between population groups are more important in magnitude than in nature. The patterns identified can stimulate further research and development into the household product and environmental contributors to childhood burn injury.

Age Distribution↗
PubMed2002

Human immunodeficiency virus type 1 Western blot: revised diagnostic criteria with fewer indeterminate results for epidemiological studies in Africa.

BACKGROUND: Western blot (WB) criteria in epidemiological studies in Africa exhibit an unacceptably high proportion of indeterminate results. New diagnostic criteria are urgently needed. METHODS: From 1989 to 1998, WB confirmatory tests were performed after weakly positive or discordant results of two enzyme immunoassays in a large Ugandan population. Enzyme immunoassays (EIA) on new sera taken prospectively from the same individuals one year later were used to assess the human immunodeficiency virus (HIV) status of these people. A logistic model was used to determine which set of WB bands was the most predictive of HIV status. Diagnostic criteria were then established, based on the likely HIV status determined using the predictive values and the intensity of the bands. RESULTS: Using 1109 WB tests, the best diagnostic criteria were based on only two bands (gp160 and p31). These criteria were validated on an independent sample of 587 WB tests, giving a high sensitivity and specificity (90.3% and 97.0%, respectively) and few indeterminate results (2.7%). These criteria classified correctly 96.3% of the sera. CONCLUSION: Our diagnostic criteria gave far better results in our population than the existing published criteria. This suggests that new criteria could be developed to improve WB interpretation in African settings.

Africa↗
PubMed1997

An investigation into neurologic and neurobehavioral effects of long-term agrichemical use among deciduous fruit farm workers in the Western Cape, South Africa.

Long-term exposure to organophosphates (OPs) in the absence of acute poisoning is increasingly suspected of causing chronic neurologic and neurobehavioral effects. A cross-sectional survey of 163 spray operators on deciduous fruit farms in the Western Cape, South Africa, and 84 nonspraying labororers was conducted in 1993 to investigate the relationship between long-term OP exposures and neurological and neurobehavioral outcomes. The study also sought to evaluate the performance of a set of neurobehavioral test batteries based on the information-processing theory of cognitive psychology, relative to the more established World Health Organization's Neurobehavioral Core Test Battery (WHO NCTB). These information-processing tests were designed for use in studies of subjects with little education, which are frequently conducted in developing countries in agriculture. They draw on experience from a previous South African study in which problems were encountered with a lack of cross-cultural validity of conventional test batteries. No evidence was found of a relationship between long-term OP exposure and loss of vibration sense. Small associations were found with the NCTB Pursuit-Aiming and Santa Ana (nondominant hand) subtests. The overall evidence of neurologic and neurobehavioral effects of long-term OP exposure was small; exposure misclassification may have contributed to this finding. Important confounders such as brain injury, alcohol consumption, and nutritional status were identified.

Agricultural Workers' Diseases↗
PubMed2005

Genetic diversity of woolly apple aphid Eriosoma lanigerum (Hemiptera: Aphididae) populations in the Western Cape, South Africa.

The woolly apple aphid Eriosoma lanigerum (Hausmann) is one of the most damaging apple pests in South Africa. Information on its genetic diversity is lacking and this study, in which the genetic structure of parthenogenetic E. lanigerum populations was characterized in the Western Cape Province of South Africa, represents the first local study of its kind. A total of 192 individuals from four different regions were collected and analysed using amplified fragment length polymorphism (AFLP). Using five selective AFLP primer pairs, 250 fragments were scored for analysis. Results indicated that a low level of genetic variation was apparent in E. lanigerum populations in the Western Cape (H = 0.0192). Furthermore, populations collected from geographically distant regions were very closely related, which can partly be explained by the fact that agricultural practices were responsible for dissemination of populations from a common ancestor to geographically distant areas. The low level of variation found indicated that the possibility of controlling E. lanigerum in the Western Cape using host plant resistance is favourable. This is the first report of AFLP being used to characterize the genetic structure of an aphid species. Results indicate that this marker may be useful for analysis of other aphid species.

Analysis of Variance↗
PubMed2002

Coastal aquaculture development in eastern Africa and the Western Indian Ocean: prospects and problems for food security and local economies.

This paper reviews the experience and status of coastal aquaculture of seaweeds, mollusks, fish and crustaceans in eastern Africa and the islands of the western Indian Ocean. In many respects, coastal aquaculture is still in its infancy in the region, and there is a pressing need to formulate development strategies aimed at improving the income and assuring the availability of affordable protein to coastal communities. This paper also draws from positive and negative experiences in other parts of the world. The requirements of feed and fry, and the conversion of mangroves are used to illustrate how some aquaculture activities constitute a net loss to global seafood production. The paper presents both general and specific sustainability guidelines based on the acknowledgement of aquaculture as an ecological process. It is concluded that without clear recognition of its dependence on natural ecosystems, the aquaculture industry is unlikely to develop to its full potential in the region.

Africa, Eastern↗
PubMed2004

Maternal and fetal single nucleotide polymorphisms in the epoxide hydrolase and gluthatione S-transferase P1 genes are not associated with pre-eclampsia in the Coloured population of the Western Cape, South Africa.

Oxidative stress is thought to play an important role in the pathophysiology of pre-eclampsia. A defect in certain enzymes responsible for detoxification may cause prolonged exposure to reactive by-products and contribute to maternal endothelial as well as placental damage. Two polymorphisms affecting the function of the biotransformation enzymes epoxide hydrolase and glutathione S-transferase P1 were shown previously to be associated with pre-eclampsia in a Dutch population. The aim of this study was to determine if these two polymorphisms (maternal or fetal) contribute to pre-eclampsia in an anthropologically distinct population (the Western Cape region of South Africa) with a high incidence of the disease. Genomic DNA of mother - infant pairs with severe pre-eclampsia (n = 144), a population control group (n = 156) and control mother - infant pairs with uncomplicated pregnancy outcome (n = 45) were analysed for the EPHX and GSTP1 polymorphisms by polymerase chain reaction amplification and restriction enzyme digestion. Each polymorphism had a similar distribution in case and control subjects (mother and infant). The Val105/Val105 genotype of GSTP1 occurred at a higher frequency than reported for other populations. Neither maternal nor fetal EPHX Tyr113His and GSTP1 Ile105Val polymorphisms appear to contribute significantly to the pathophysiology of pre-eclampsia in the Coloured population of the Western Cape region of South Africa.

Alleles↗
PubMed2006

Bone breccias, bone dumps, and sedimentary sequences of the western Limeworks, Makapansgat, South Africa.

The sediments in the western side of the Makapansgat Limeworks were either precipitated as speleothems, represented in the earlier massive deposits, or were deposited as coarsening clastic sediments, mainly representing later deposits. Between the earlier deposits and the main sedimentary phase, the stratigraphic sequence was inverted twice to a considerable height by the unusual deposition of subaqueous speleothem. Bone-bearing deposits, including the Main Quarry Bone Breccia and the well-known Grey Breccia belong, in time, to the lower part of the clastic deposits called the Red Silts. Australopith fossils have been found in the Grey Breccia dumped material and, in situ, from the dolomite clast breccia on the Main Quarry entrance buttress. Whatever the problems may be in provenancing some of the material from the Limeworks dumps, there is no doubt that the three rows of blocks on the southern side of the dumps belong to the Grey Breccia, and other rows contain red sediment sufficient for them to be safely associated with the Red Silts. There is no reason why this material should not be prepared with confidence as to its stratigraphic provenance. In any case, stratigraphic evidence, presented here, shows that there is little difference in time between the deposition of the bone-bearing breccias.

Animals↗