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PubMed2000

Status of a health care quality review programme in South Africa.

This paper provides an overview of an accreditation programme for health care facilities in South Africa. It traces the origin of COHSASA (The Council for Health Service Accreditation of Southern Africa) which began as a pilot programme in 1992, to its current status as the only accreditation body in the country. There are brief descriptions of its structure, how it is governed, and how standards were developed and organized. The authors sketch a background of the unique sociopolitical context and legal developments within which the programme operates in South Africa and how the programme is contributing towards the new government's intention to provide equitable and quality health care to all its citizens. There is an outline of the principles on which the COHSASA programme is based and the structure and process of the programme. The programme incorporates an integrated, multi-disciplinary, continuous quality improvement approach with special emphasis on capacity building of hospital staff when necessary. The paper refers to groundbreaking research in Kwa-Zulu Natal where the impact of accreditation is being measured in a randomized control trial. It points to the benefits of accreditation being perceived in both public and private sectors of health care in South Africa and outlines some of the results of the program's implementation.

Accreditation↗
PubMed2002

Revised age estimates of Australopithecus-bearing deposits at Sterkfontein, South Africa.

The Sterkfontein fossil site in South Africa has produced the largest concentration of early hominin fossils from a single locality. Recent reports suggest that Australopithecus from this site is found within a broad paleontological age of between 2.5-3.5 Ma (Partridge [2000] The Cenozoic of Southern Africa, Oxford: Oxford Monographs, p. 100-125; Partridge et al. [2000a], The Cenozoic of Southern Africa, Oxford: Oxford Monographs, p. 129-130; Kuman and Clarke [2000] J Hum Evol 38:827-847). Specifically, the hominin fossil commonly referred to as the "Little Foot" skeleton from Member 2, which is arguably the most complete early hominin skeleton yet discovered, has been magnetostratigraphically dated to 3.30-3.33 Ma (Partridge [2000] The Cenozoic of Southern Africa, Oxford: Oxford Monographs, p. 100-125; Partridge et al. [2000a], The Cenozoic of Southern Africa, Oxford: Oxford Monographs, p. 129-130). More recent claims suggest that hominin fossils from the Jacovec Cavern are even older, being dated to approximately 3.5 Ma. Our interpretation of the fauna, the archeometric results, and the magnetostratigraphy of Sterkfontein indicate that it is unlikely that any Members yet described from Sterkfontein are in excess of 3.04 Ma in age. We estimate that Member 2, including the Little Foot skeleton, is younger than 3.0 Ma, and that Member 4, previously dated to between 2.4-2.8 Ma, is more likely to fall between 1.5-2.5 Ma. Our results suggest that Australopithecus africanus should not be considered as a temporal contemporary of Australopithecus afarensis, Australopithecus bahrelghazali, and Kenyanthropus platyops.

Animals↗
PubMed2005

Human immunodeficiency virus (HIV) and suicide in a region of Eastern Province ("Transkei"), South Africa.

HIV/AIDS is an alarming illness worldwide. It is known to have a significant association to suicide, despite a lack of in depth study. Early studies suggested suicide risk 20 to 36 times higher than the general population, but more recent trends in America show a decline. This is not true in Africa, including the region of Eastern Province, South Africa. There is abundant political and health discussion, but little study. This article presents descriptive statistics and case histories. These beginning studies must be augmented by comprehensive study of not only the epidemiology, but also the psychological and social correlates. Regrettably, there are numerous obstacles to such study in South Africa.

Adult↗
PubMed1998

National HIV surveillance in South Africa--1993-1995.

OBJECTIVE: To determine the point prevalence of HIV infection by serological examination which, performed consistently over several years, serves to monitor the distribution and trend of the HIV epidemic in South Africa. DESIGN: Annual cross-sectional surveys conducted nationally, in October/November. SETTING: South Africa, including areas that used to be known as self-governing and independent national states. SUBJECTS: Pregnant women in the age group 15-49 years who attend antenatal clinic services provided by the public health services. OUTCOME MEASURES: HIV positivity as determined serologically. RESULTS: The rising trend found previously continues: HIV positivity in South Africa was found to be 4.25% in 1993, 7.57% in 1994 and 10.44% in 1995. In 1995 the highest rate was recorded in KwaZulu-Natal (18.23%) and the lowest in the Western Cape (1.66%). On the basis of certain assumptions it is estimated that these rates are indicative of 1.7 million sexually active adults having been infected with HIV by October/November 1995, plus a cumulative total of 40,000 infants. Women in their 20s had the highest age-specific prevalence rates, viz. 13.12% (20-24 years) and 11.03% (25-29 years). HIV positivity in pregnant teenagers was 9.5%. CONCLUSIONS: The HIV epidemic is firmly established in South Africa with a wide variation in provincial prevalence rates. Of particular public health significance is the finding of a high and rising prevalence rate in pregnant teenagers. The observed prevalence rate for 1995 is lower than expected, giving rise to guarded hope that provinces with the highest recorded rates are moving away from the exponential growth found hitherto.

Adolescent↗
PubMed1999

Who fails to complete tuberculosis treatment? Temporal trends and risk factors for treatment interruption in a community-based directly observed therapy programme in a rural district of South Africa.

SETTING: Hlabisa Tuberculosis Programme, Hlabisa, South Africa. OBJECTIVE: To determine trends in and risk factors for interruption of tuberculosis treatment. METHODS: Data were extracted from the control programme database starting in 1991. Temporal trends in treatment interruption are described; independent risk factors for treatment interruption were determined with a multiple logistic regression model, and Kaplan-Meier survival curves for treatment interruption were constructed for patients treated in 1994-1995. RESULTS: Overall 629 of 3,610 surviving patients (17%) failed to complete treatment; this proportion increased from 11% (n = 79) in 1991/1992 to 22% (n = 201) in 1996. Independent risk factors for treatment interruption were diagnosis between 1994-1996 compared with 1991-1993 (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.6-2.4); human immunodeficiency virus (HIV) positivity compared with HIV negativity (OR 1.8, 95%CI 1.4-2.4); supervised by village clinic compared with community health worker (OR 1.9, 95%CI 1.4-2.6); and male versus female sex (OR 1.3, 95%CI 1.1-1.6). Few patients interrupted treatment during the first 2 weeks, and the treatment interruption rate thereafter was constant at 1% per 14 days. CONCLUSIONS: Frequency of treatment interruption from this programme has increased recently. The strongest risk factor was year of diagnosis, perhaps reflecting the impact of an increased caseload on programme performance. Ensuring adherence to therapy in communities with a high level of migration remains a challenge even within community-based directly observed therapy programmes.

Adolescent↗
PubMed2005

WHO framework convention on tobacco control and its relevance to the dental professions in South Africa.

One in nine deaths in South Africa is related to tobacco use. Recognition of the need for global partnership to curb the tobacco epidemic has led to the WHO member states' adoption of the first global public health treaty--the framework convention for tobacco control (FCTC). Relevant to the dental profession, within the FCTC's guiding principle of the need to protect all persons from the initiation, maintenance or increase of tobacco use are articles 12 and 14. These challenge parties to take action to train health workers and to secure treatment for tobacco dependence. Preventing initiation of tobacco use by youths is as fundamental to the prevention of periodontal disease and oro-pharyngeal cancer as providing fluoride and dental sealants for the prevention of dental caries. Tobacco control, whether in private practice or in public service, must be viewed within the context of an ethical obligation for primary prevention. There are science-based clinical guidelines for implementing tobacco prevention and tobacco cessation. Dentists who implement an effective cessation programme in their practices can expect to achieve quit rates of 10-15% each year. However, this primary prevention effort can be no better than the knowledge, skills and values of the practitioners providing the service. The FCTC may change the environment that dentistry is practised in globally. The relevant stakeholders in the dental profession should therefore assume stewardship by providing support for the training of dental professionals in tobacco counselling and advocate for the adequate reimbursement of practitioners providing such services.

Adult↗
PubMed2006

The impact of a change in bacille Calmette-Guérin vaccine policy on tuberculosis incidence in children in Cape Town, South Africa.

BACKGROUND: A decision by the South African National Department of Health to change the route of administration and strain of bacille Calmette-Guérin (BCG) vaccine was implemented in Cape Town, South Africa, between July and December 2000. This provided an opportunity to compare the incidence of tuberculosis and proportion with disseminated disease in children less than 2 years old before and after the changeover from percutaneous (PC) Tokyo 172 BCG to intradermal (ID) 1331 Danish BCG immunization. METHODS: Clinical records of all tuberculosis patients aged less than 2 years at diagnosis and born between January 1, 1999, and June 30, 2000 (PC cohort) and between January 1, 2001, and June 30, 2002 (ID cohort) were collected. All cases were reviewed for likelihood of TB, its severity and disease dissemination. RESULTS: The number of reported patients with tuberculosis in the PC cohort was 1369 and in the ID cohort 1397, giving incidence rates of 866 (95% confidence interval [CI], 821-913) and 858 (95% CI, 814-904) per 100,000 person-years, respectively. The proportion who had disseminated disease (meningitis and/or miliary spread) was significantly lower in the ID cohort (4.7%) than in the PC cohort (8.6%) (relative risk, 0.54; 95% CI, 0.40-0.72). Those not vaccinated had a significantly higher proportion of disseminated disease cases (29.2%) than the PC and ID groups combined (6.6%) (relative risk, 4.4; 95% CI, 2.7-6.7). CONCLUSION: A program using Danish 1331 BCG given intradermally did not prevent more tuberculosis cases in children overall as compared with a program using Tokyo 172 BCG given percutaneously but reduced the proportion with disseminated disease.

Cohort Studies↗
PubMed2002

What motivates lay volunteers in high burden but resource-limited tuberculosis control programmes? Perceptions from the Northern Cape province, South Africa.

SETTING: The Northern Cape province, Republic of South Africa. OBJECTIVES: To explore factors that motivate lay volunteers to join tuberculosis (TB) control programmes in high burden but resource-limited settings. DESIGN: A qualitative study consisting of three focus group discussions and a documentary review of the records of 347 lay volunteers involved in the tuberculosis programme in the Northern Cape province of South Africa. Additional data were also collected in a cross-sectional study that involved questionnaire interviews with 135 lay volunteers. SUBJECTS: Lay volunteers in the TB programme. One focus group discussion was also carried out with youth not involved in the TB programme. RESULTS: Volunteers do not receive any monetary incentives in the TB programme in the Northern Cape province, but due to the high level of unemployment in this setting, hope for eventual remuneration was found to be the strongest factor motivating youth to join the programme. The study found attrition rates among volunteers to be high (22% had dropped out of the programme within one year of joining); 75% of the dropouts gave loss of interest and a desire for paid work as the reasons for leaving the TB programme. Other motivating factors identified included altruism, a need to find something to do with one's spare time, gaining work experience, and the novelty of the community-based TB programme. CONCLUSION: In the absence of monetary incentives, attrition rates of lay volunteers may be high and this can threaten the effectiveness of community-based TB programmes. In resource-limited settings, it is important to identify and implement appropriate alternative incentives that could motivate lay persons in order to sustain community participation in high TB burden areas.

Adolescent↗
PubMed1993

Rabies in bat-eared foxes in South Africa.

Rabies in bat-eared foxes was first recognized in South Africa in 1955 and is likely to have been derived from canine rabies introduced to South Africa in 1950. Since then it has become established in this species in the drier western half of the country and the south-western Cape so that rabies now occurs in bat-eared foxes adjacent to the peri-urban canine population of Cape Town. Peak incidence was recorded in the early 1980s and the incidence is seasonal with most cases occurring in winter.

Animals↗
PubMed2005

International EMS systems in South Africa--past, present, and future.

Emergency medical services (EMS) in South Africa have developed rapidly over the last 20 years. However, there is inequitable distribution of services, with many rural areas being poorly resourced. This is partly as a result of the historical inequalities prevalent in the South African society of the past; efforts are being made to address this. EMS training is provided at basic, intermediate and advanced levels. The advanced level of training is comparable with the best in the world. Emergency care practitioners are registered with the Health Professions Council of South Africa and are thereby subject to the regulations, scope of practice and disciplinary structures of the council. Response times vary from 15 min in sophisticated urban systems to 40 min or longer in some rural services. Emergency departments (ED) are very busy, usually overloaded with patients, often poorly resourced and are similar to "Casualty Departments" that existed in the UK in the past. Facilities, staff and equipment are variable, and until recently there has been no formal career structure for emergency doctors. The introduction of emergency medicine as a new full speciality in 2004 will transform emergency care in Southern Africa, and appropriate training programmes are already being developed, together with progressive upgrading of emergency departments. EMS personnel face a vast spectrum of clinical cases, particularly all forms of trauma. Recent improvements in organisation, education and resources, coupled with better distribution of services, upgraded emergency departments and the development of emergency medicine as a speciality, should provide a significant boost for emergency care for the community.

Emergency Medical Service Communication Systems↗
PubMed2005

Epilepsy in South Africa.

Since its first democratic elections in 1994, South Africa has undertaken a massive social reconstruction program that has included major healthcare reform. The state healthcare system aims to provide a unitary service, based on a primary healthcare approach, to the 85% of the population who depend on it. Although the burden of epilepsy is largely unknown, it is likely to be large, with a study of children in a large rural community, for example, demonstrating an active prevalence of 6.7/1000. Common causes of epilepsy are likely to include infectious diseases, such as neurocysticercosis and HIV/AIDS, trauma and alcohol consumption. Limited evidence suggests the existence of a large treatment gap in some areas. The management and treatment of epilepsy are also greatly influenced by cultural attitudes and beliefs, which vary widely. South Africa thus provides a microcosm of issues affecting the management of epilepsy worldwide.

AIDS-Related Opportunistic Infections↗
PubMed1992

Treatment and control of sheep scab (Psoroptes ovis) with ivermectin under field conditions in South Africa.

Four trials including 11,266 sheep were conducted in South Africa to evaluate the efficacy of the systemic parasiticide ivermectin against field outbreaks of sheep scab (Psoroptes ovis) when two doses of approximately 200 micrograms/kg were administered subcutaneously seven days apart (days 0 and 7). As sheep scab is a notifiable disease in South Africa, it was not possible to include an untreated control group. The prevalence of clinically affected animals in the four treated flocks varied from 0.4 per cent to 99 per cent before the two treatments. After the treatments, there were no signs of active clinical infection in any of the sheep between days 28 and 30, or at subsequent examinations. P ovis mites were recovered from scrapings from 114 of 127 indicator sheep before the treatment but no mites were recovered from them between days 28 and 30 or 42 and 58 after the treatments.

Animals↗
PubMed1996

The distribution, diagnoses and estimated economic impact of plant poisonings and mycotoxicoses in South Africa.

Maps are provided showing the national and provincial distributions of many plant poisonings and mycotoxicoses in South Africa. The various poisonings are briefly described and criteria for their diagnoses are given. The annual mortalities of cattle from plant poisonings/mycotoxicoses in South Africa were calculated as c. 37 665 head with a current cash value of c. R57 627 450, and that of small stock as c. 264851 head with a value of c. R46 878 627. The annual total cost of plant poisonings/mycotoxicoses to the livestock industry of South Africa is conservatively estimated at R104 506 077. These figures do not include hidden losses such as diminished production, reproductive failure, the cost of not utilizing toxic pastures and the fall in price of infested land.

Animals↗
PubMed1997

Growth monitoring--is it a task worth doing in South Africa?

Childhood undernutrition is a serious public health problem in South Africa. Growth monitoring (GM) is a central tool in attempts to prevent and detect undernutrition. Despite its widespread adoption by international and national agencies, there has been very little evidence which shows that it has made an impact in reducing undernutrition. An important problem has been the conceptual confusion as to the exact role of GM. This article reviews the international evidence for the effectiveness of GM when used in various roles and proposes some of the factors necessary for GM to be successful in South Africa.

Child↗
PubMed2001

Evidence for action? Patterns of clinical and public health research on tuberculosis in South Africa, 1994-1998.

OBJECTIVES: To describe patterns of clinical and public health research into tuberculosis in South Africa from 1994-1998, and to assess the quality of studies of diagnostic accuracy and treatment. DESIGN: MEDLINE and the African Health Anthology were searched for journal articles published from 1994-1998 reporting clinical and public health research into tuberculosis in South Africa. Information extracted from the reports included research setting, study design, aspects of the quality of study design and reporting, and evidence of attention to statistical power. RESULTS: One hundred and thirty-five eligible studies were identified; 39 (28.9%) of the studies were case reports or case series. Important methodological flaws were identified in studies of diagnosis and treatment that compromised the validity of the study results. Of the 28 studies assessing interventions, 10 (35.7%) were randomised controlled trials with only one reporting adequate allocation. Of the 34 studies assessing diagnosis, 16 (47.0%) were cross-sectional assessments of diagnostic accuracy, and none reported that comparison of the reference standard was independent or blind. Fifty-four (79.4%) of the analytical studies with statistically non-significant results showed no evidence of consideration of sample size. CONCLUSION: The usefulness of tuberculosis research in South Africa is compromised by the questionable validity of many studies and a lack of attention to sample size.

Case-Control Studies↗