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PubMed1992

An outbreak of multiresistant Salmonella typhi in South Africa.

Typhoid fever caused by Salmonella typhi remains endemic to many parts of South Africa, including Natal and KwaZulu, Northern Transvaal and the Transkei. Until recently, the majority of S. typhi isolates from South Africa have remained susceptible to ampicillin/amoxycillin and chloramphenicol, and only three cases of typhoid due to multi-antibiotic resistant strains of S. typhi have been documented. Ampicillin/amoxycillin and chloramphenicol are, therefore, still recommended as first line therapy for patients with typhoid fever in this country. We describe a cluster of six cases of typhoid caused by S. typhi that was resistant to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. All these patients presented over a 3-month period; the patients were from three adjacent districts in the Northern Natal area of South Africa. The high rate of intestinal perforation (two of six) was a direct consequence of inappropriate antibiotic treatment. Failure of surgical intervention, renal impairment as well as delay in starting appropriate antibiotic treatment were factors contributing to the high mortality (three of six). The good clinical outcome in the remaining three patients probably resulted from treatment with appropriate antibiotics; however, mild disease in two of these patients may have been a contributing factor. All isolates showed high minimal inhibitory concentrations (MIC) of greater than or equal to 256 micrograms/ml to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. The isolates were all highly sensitive to the third generation cephalosporins (MIC less than or equal to 0.06 micrograms/ml) and quinolones (MIC less than or equal to 0.03 micrograms/ml). Conjugation studies suggest a genetic transfer of resistance, probably plasmid mediated. The presence of beta-lactamase and chloramphenicol acetyl transferase enzymes in all six isolates tested would account for the resistance to ampicillin and chloramphenicol respectively. The transfer of such plasmids to erstwhile sensitive strains could conceivably occur in this typhoid-endemic area, where sanitary conditions are poor and living conditions crowded, thus further exacerbating the problem. It is recommended that in areas where such multiresistant strains are encountered, the third generation cephalosporins or quinolones be used as empiric therapy for typhoid fever.

Adult↗
PubMed2002

Prevalence of household food poverty in South Africa: results from a large, nationally representative survey.

OBJECTIVES: Household food insecurity is a major determinant of undernutrition, yet there is little information on its prevalence in the South African population. This paper assesses household food insecurity in South Africa using a quantitative and objective measure, known as food poverty, and provides prevalence estimates by geographic area and socio-economic condition. DESIGN: Secondary data analysis combining two sources: Statistics South Africa's household-based 1995 Income and Expenditure Survey; and the University of Port Elizabeth's Household Subsistence Level series, a nationally-conducted, market-based survey. SETTING: South Africa. SUBJECTS: A nationally representative sample of the entire country - stratified by race, province, and urban and non-urban areas - consisting of 28 704 households. RESULTS: A household is defined to be in food poverty when monthly food spending is less than the cost of a nutritionally adequate very low-cost diet. The prevalence of food poverty in South Africa in 1995 was 43%. Food poverty rates were highest among households headed by Africans, followed by coloureds, Indians and whites. Higher food poverty rates were found with decreasing income, increasing household size, and among households in rural areas or those headed by females. CONCLUSIONS: The widespread nature of household food insecurity in South Africa is documented here. Prevalence rates by geographic and socio-economic breakdown provide the means for targeting of nutritional interventions and for monitoring progress in this field. The corroboration of these findings with both internal validation measures and external sources suggests that food poverty is a useful, objective measure of household food insecurity.

Adult↗
PubMed1993

A host-parasite list of the haematozoa of domestic poultry in sub-Saharan Africa and the isolation of Plasmodium durae Herman from turkeys and francolins in South Africa.

An annotated host-parasite list of the blood parasites of domestic poultry in sub-Saharan Africa is presented. This list contains the haematozoa found in domestic waterfowl (ducks, geese and muscovies) and phasianids (turkey, fowl and peafowl). In South Africa Plasmodium durae was isolated from 4 out of 8 backyard turkeys, from 3 out of 26 Swainson's francolins and from 1 redwing francolin, but not from 20 helmeted guineafowls and 9 greywing francolins. This points at Swainson's and redwing francolins as being the main natural hosts of P. durae in South Africa. The increase in the period of prepatency after intramuscular subinoculation as compared with the intravenous route was found to correspond to that of a 1,000 fold dilution of an intravenous inoculum of parasitized blood. This delay was not due to an intervening cycle of exoerythrocytic schizogony, but to large numbers of the injected erythrocytes apparently not finding their way into the circulation of the new host.

Animals↗
PubMed1998

Lead poisoning of children in Africa, IV: Exposure to dust lead in primary schools in south-central Durban, South Africa.

Twenty primary schools in three areas (Merebank, Austerville and Bluff) of south-central Durban, South Africa were studied to determine if dust lead loading (microgram/m2) is high enough to constitute a risk to children. Atmospheric lead fallout rates in the schools varied from 9 to 264 micrograms/m2 per day and were higher than the values now being reported in the developed countries. Mean outside dust lead loadings were 425 micrograms/m2 in Merebank, 771 micrograms/m2 in Austerville and 1174 micrograms/m2 in Bluff areas, and 25% of the primary schools were found to have mean outside dust lead loading above 1000 micrograms/m2. Mean dust lead loadings inside classrooms were 2-4 times lower than the outside rates, and showed no significant difference among schools in the three areas. Dust lead loadings were correlated with lead concentrations in dust but not with distance from the highway or with atmospheric lead deposition rates. Exposure to dust lead in classrooms and in the school yard is considered to be an important contributor to blood lead levels in, and hence a potential health hazard to, children in many urban areas of the city.

Africa↗
PubMed1989

Personal violence (suicide and homicide) in South Africa.

An examination of recent suicide and homicide rates in the United States and South Africa showed quite similar patterns, with whites having higher rates of suicide and nonwhites having higher rates of homicide. In recent years, suicide rates for white males have risen in South Africa while remaining stable in the United States. In contrast, homicide rates have risen for nonwhites in South Africa.

Black or African American↗
PubMed1997

Abiotic and biotic determinants of the seasonal dynamics of the tick Rhipicephalus appendiculatus in South Africa.

The creation of a generic population model for the tick Rhipicephalus appendiculatus requires a detailed, quantified understanding of the interactions of these ticks with their biotic and abiotic environment in the different parts of their range, from the tropical regions of East Africa to the temperate regions of South Africa. The much greater seasonal variation in climatic conditions, particularly temperature, further from the equator introduces variable development rates and diapause into the life cycle. Estimates of natural temperature-dependent interstadial development periods, derived from a combination of published laboratory and field data, were applied to published data on the seasonal abundance of R.appendiculatus on three farms in the Eastern Cape Province of South Africa. This enabled an assessment of which ticks of one stage give rise to which ticks of the next stage, from which (a) the onset and duration of diapause in unfed adults, and (b) seasonal interstadial mortality indices in the form of k-values, could be estimated. The contribution of biotic (tick density) and abiotic (climatic) factors as predictors of mortality at each life stage was investigated by step-wise multiple regression. Density-independent mortality at the female-to-larval stage is correlated with geographically variable climatic factors, minimum temperature at two farms and minimum relative humidity at the third. The other two stages are governed by density-dependent mortality, which, it is argued, may be caused largely by the hosts' acquired resistance to ticks. As expected on theoretical grounds, this density dependence is weaker nearer to the edge of the tick's range and for the more vulnerable immature stages.

Animals↗
PubMed2003

"To know or not to know": service-related barriers to voluntary HIV counseling and testing (VCT) in South Africa.

Voluntary HIV Counselling and Testing (VCT) is still in its infancy in South Africa, and although the necessary infrastructure in terms of clinics and hospitals exists, a VCT culture is not yet established in the country. The purpose of this study was to determine the needs, attitudes and beliefs of a sample of South Africans towards VCT, and to investigate possible barriers affecting participation in VCT programs in South Africa. A semi-structured questionnaire was used to survey the views of 1422 people. Results indicate that while subjects were not opposed to VCT in principle, 33% would go to clinics where nobody would know them. The following problems with VCT services were mentioned: Logistical problems (not enough counsellors, long lines, lack of privacy); no trust in the health care system or fearing a breach of confidentiality; fear of rejection; and a lack of follow-up support after diagnosis. Suggestions are made on how to improve VCT services in South Africa.

Adult↗
PubMed2004

Globalisation and local power: influences on health matters in South Africa.

This paper reviews some of the multiple influences on health issues in South Africa, placing them in the context of globalisation. By examining the complexity of factors, both domestic and global, which impact on these issues, it questions the extent to which global patterns in areas such as health policy, HIV/AIDS, health care pluralism, and neo-liberal macroeconomic policy have played out in South Africa. The identification of some of the multiple and complex forces in each case reveals a relatively consistent story of global pressures interacting with domestic realities, with some recognizably local results. There is no doubt that a full and nuanced understanding of health in South Africa requires an appreciation of developments in the global political economy, international organizations such as the WHO and World Bank, and forces which operate outside of institutions. In each case, however, the specific opportunities available to actors within the country, as well as the relative power of those actors, should be given their due consideration in analysing their potential impact on health matters.

HIV Infections↗
PubMed1999

Are the oral manifestations associated with HIV infection really relevant to the practising South African dentist? A comparative analysis of oral HIV studies in South Africa.

This comparative analytical review of oral HIV in South Africa, Africa and the West shows that relatively little work has been done on the African continent in this field of study. Direct epidemiological comparisons of these studies with each other are difficult but were made between these regions for overall prevalence values, mode of transmission and individual lesion presentation (candidiasis, oral hairy leukoplakia, periodontal disease, Kaposi's sarcoma, salivary gland disease, oral ulcers and other lesions). Apparent differences exist between the reported prevalence values of oral candidiasis, periodontal disease, Kaposi's sarcoma and tuberculous ulcers, the significance of which is uncertain. There is a need to standardise research methodologies. This would enable appropriate comparisons to be made and a better understanding of the implications of the oral HIV disease process in South Africa and elsewhere on the continent.

AIDS-Related Opportunistic Infections↗
PubMed1997

Urbanisation and women's health in South Africa.

For many decades the migrant labor system and the influx control legislation in South Africa exacerbated male-dominant patterns of migration typical of Africa. In recent years, however, and especially following the easing of influx control legislation in 1986, migration in South Africa has increasingly involved women. This paper reports on a study conducted in Khayelitsha, Cape Town, which explored the relationship between urbanisation and the health of women. The objectives were to relate age, migration, length of stay in urban areas, employment status, and occupation to the health, including reproductive health, of women living in Khayelitsha. Interviews with 659 women (61 households had no senior woman) revealed that women enjoyed considerable social support through their neighbours, church organisations, and women's organisations. Women who lived in the most deprived section of Khayelitsha enjoyed more support from their neighbours but reported less satisfaction with the area in which they lived. Child-care support was poor and a considerable proportion of the women were disempowered by their male partners. More than 90 percent of the women had access to antenatal care. Recent immigrants had more pregnancies, were less aware of screening for cervical cancer, less likely to have had a Pap smear, less knowledgeable about where to have a Pap smear done, and less likely to have heard AIDS. More women were aware of AIDS (86%) than Pap smears (45%). More than half of those of childbearing age used contraception, mainly intramuscular hormones (76%). A significant proportion (53%) of the women reported that they had had their first pregnancy as teenagers and younger, less educated women were more likely to have had adolescent pregnancies. Policy makers are confronted by a compelling need to redress well-known urban-rural inequalities in health care in South Africa. Policy attention must also be given to the increasing urbanisation of women and the growing health care needs in urban areas.

Adult↗
PubMed2001

Occupational respiratory diseases in South Africa--results from SORDSA, 1997-1999.

OBJECTIVES: To describe the nature and extent of work-related respiratory diseases reported to the national Surveillance of Work-related and Occupational Respiratory Diseases in South Africa (SORDSA) reporting scheme. The causative agents and industrial categories in which they occurred are also characterised. DESIGN: Voluntary monthly reporting of newly diagnosed cases by pulmonologists, occupational medicine practitioners and occupational health nurses. SETTING: Medical and occupational health referral centres in the nine provinces of South Africa. SUBJECTS: Cases were workers from non-mining industries or ex-miners, suffering from a newly diagnosed occupational respiratory disease, reported to SORDSA between October 1996 and December 1999. OUTCOME MEASURES: Frequencies of reported occupational respiratory disease by year, reporting source, province and sex. Frequencies of short- and long-latency diseases by industry and causative agent. RESULTS: There was incomplete reporting coverage of the nine provinces in the first 3 years. Reporting was most comprehensive from Gauteng, KwaZulu-Natal and the Western Cape. Diseases with long latency periods made up 76.2% of the cases. Pneumoconiosis, even in non-mining industries, was the most frequently reported disease, followed by inhalation accidents. Occupational asthma was the fourth most reported disease. Apart from the prominence of pneumoconiosis, the results obtained by SORDSA are similar to those from a British occupational lung disease surveillance scheme. This study showed that newly diagnosed cases of occupational lung disease occurred in many industries and were caused by a variety of agents. CONCLUSION: SORDSA has contributed insight into the nature, extent and distribution of occupational respiratory diseases in South Africa. It has also highlighted important causes of occupational respiratory diseases in South Africa, as well as hazardous industries. The data indicate that South Africa has a widespread occupational lung disease problem, and provide a platform for targeted prevention strategies.

Accidents, Occupational↗
PubMed2005

The National Food Consumption Survey (NFCS): South Africa, 1999.

OBJECTIVE: The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1-9 years old), as well as factors that influence their dietary intake. DESIGN: This was a cross-sectional survey of a nationally representative sample of all children aged 1-9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information. SUBJECTS: Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%. METHODS: The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a food-frequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference. RESULTS: At the national level, stunting (height-for-age below minus two standard deviations (< -2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age < -2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1-3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure. CONCLUSION: The NFCS indicated that a large majority of households were food-insecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa.

Anthropometry↗
PubMed1993

The Ray Alexander Workers Clinic--a model for worker-based health services in South Africa?

During the period of current political transition, concern for the future of South Africa's health services have led to increased interest in different models for the provision and financing of health care. These debates have included an examination of the concept of Managed Care and the ideas of Health Maintainance Organization. Progressive trade unions, particularly, have been faced with the prospect of promoting private sector health care if they are directly to meet their members health needs, while at the same time seeking an equitable health care system for a future democratic South Africa. The Ray Alexander Workers Clinic is presented as a model of a worker-based health service which attempts to address this contradiction. Important lessons for a future National Health Service may be learnt. The role of worker control and cost containment are emphasized and implications for integration into State Services and relationships to social services for the broader community are explored. An argument is made that worker-based health services offer excellent possibilities for integration in a future National Health Service in South Africa that is centred on a Primary Health Care approach.

Ambulatory Care Facilities↗
PubMed1996

Fluoridation in South Africa.

The issues on fluoridation, fluorosis and fluorides in South Africa have been reported for the last 50 years. Efforts to implement water fluoridation between 1960 and 1980 failed partly due to lack of government action and a strong anti-fluoride lobby. The political change in South Africa since 1994 has given new support from the Ministry of Health for enabling legislation to implement water fluoridation in metropolitan areas where the technical support and some 55 per cent of the population reside. Fluoridation also addresses the equitable distribution of resources and access to a known benefit.

Adolescent↗
PubMed2002

South Africa: a toxicologist's goldmine.

The emerging nation of South Africa, in common with some other countries, notably Eastern Europe, is heir to decades of neglect with regards to the exposure of the majority of its population to toxic materials. In this short review, the major toxic health hazards are described. For most of these risks there are now programs in place to improve the situation, but co-ordination and financial constraints, along with the fact that the majority of the population neither live, nor work, in a controlled environment, mean that much remains to be done. The recent formation of a South African Toxicology society, which strives to bring together environmental, industrial, forensic and clinical toxicology should assist in an improvement, both in the epidemiology of toxicity in South Africa and in improved measures to reduce the incidence of preventable noncommunicable diseases related to both acute and chronic exposure to toxins. The South African scene also provides a "window' of opportunity to study the more fundamental aspects of exposure in human subjects and to couple these to animal and in vitro studies to elucidate the underlying mechanisms where these are unknown.

Animals↗
PubMed2003

Review of blackfly (Diptera: Simuliidae) control in South Africa.

The medical, veterinary and economic importance of blackflies in South Africa, and the historical development of blackfly control programmes in various South African rivers, are reviewed in this paper. In 1996 it was estimated that blackflies can cause more than R 88 million damages per annum along the middle and lower Orange River where Simulium chutteri is considered the main pest species. A clear link between the construction of dams and the spread of the blackfly problem was shown. Four phases characterize the development of blackfly control in South Africa: (1) during the 1960s blackflies in the Vaal River were controlled with DDT; (2), during the 1970s and into the 1980s blackflies were controlled using water-flow manipulation; (3) when used at strategic times, water-flow manipulation could be used to enhance the effect of natural predator populations; and (4) during the 1990s the organophosphate temephos and toxins produced by the bacterium Bacillus thuringiensis var. israelensis were tested for their efficacy against blackflies. The larvicides temephos and B. thuringiensis proved to be effective and are still used in several control programmes. The latest research focuses on the factors that influence adult blackfly survival and annoyance, as well as the development of methods that can be used to protect sheep from blackfly attacks.

Animals↗