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PubMed2006

Facilitating cleft palate team participation of culturally diverse families in South Africa.

OBJECTIVE: The Facial Cleft Deformities Clinic, University of Pretoria, Pretoria, South Africa, provides interdisciplinary team services to patients with cleft lip and palate and craniofacial anomalies. They represent the "rainbow nation" of South Africa and reflect the multicultural and multilingual nature of the population, which poses a challenge to effective and accountable service delivery. The aim of this study was to explore some cultural variations that exist in black families that influence their participation in the team approach and to describe the assets of families that may be used to empower them and to enhance service delivery. DESIGN: A descriptive survey research design. A questionnaire-by-interview procedure was utilized during routine visits of 35 black families to the Facial Cleft Deformities Clinic. RESULTS: The results are discussed from an ethnographic perspective of the family and describe the knowledge base of the participants, the diagnosis and treatment of the children's cleft lip and palate, family structure and support systems, family income and education, and the geographical distribution of the participants. Implications for building family partnerships and for improving professionals' cultural competence in order to improve the quality of service delivery are presented. CONCLUSIONS: By viewing cultural differences on a continuum, following the asset-based approach, applying knowledge based on contextually relevant research, and recognizing family uniqueness, families may be empowered to participate fully in the team approach to support their children with cleft lip and palate and craniofacial anomalies in attaining their full potential in the South African context.

Adolescent↗

PubMed1998

beta-Lactamases responsible for resistance to expanded-spectrum cephalosporins in Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis isolates recovered in South Africa.

Although resistance to the expanded-spectrum cephalosporins among members of the family Enterobacteriaceae lacking inducible beta-lactamases occurs virtually worldwide, little is known about this problem among isolates recovered in South Africa. Isolates of Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis resistant to expanded-spectrum cephalosporins recovered from patients in various parts of South Africa over a 3-month period were investigated for extended-spectrum beta-lactamase production. Antibiotic susceptibility was determined by standard disk diffusion and agar dilution procedures. Production of extended-spectrum beta-lactamases was evaluated by using the double-disk test, and the beta-lactamases were characterized by spectrophotometric hydrolysis assays and an isoelectric focusing overlay technique which simultaneously determined isoelectric points and general substrate or inhibitor characteristics. DNA amplification and sequencing were performed to confirm the identities of these enzymes. The P. mirabilis and E. coli isolates were found to produce TEM-26-type, SHV-2, and SHV-5 extended-spectrum beta-lactamases. An AmpC-related enzyme which had a pI of 8.0 and which conferred resistance to cefoxitin as well as the expanded-spectrum cephalosporins was found in a strain of K. pneumoniae. This is the first study which has identified organisms producing different extended-spectrum beta-lactamases from South Africa and the first report describing strains of P. mirabilis producing a TEM-26-type enzyme. The variety of extended-spectrum beta-lactamases found among members of the family Enterobacteriaceae isolated from major medical centers in South Africa is troubling and adds to the growing list of countries where these enzymes pose a serious problem for antimicrobial therapy.

Cephalosporin Resistance↗

PubMed2000

Knowledge, self-efficacy and behavioural intent towards AIDS prevention behaviours among culturally diverse secondary school pupils in South Africa.

OBJECTIVE: To investigate knowledge, self-efficacy, and behavioural intent towards AIDS prevention behaviours among culturally diverse secondary school pupils in South Africa. DESIGN: Randomised study. SETTING: Three urban secondary schools in Pietersburg, South Africa. PARTICIPANTS: Three hundred and sixty six Grade 11 secondary school pupils, comprising 150 (41%) males, and 216 (59%) females, aged 17 to 24 years (mean age 19.3 years, SD=2.6). The three cultural groups were 142 Blacks, 112 Whites and 112 Asians. MAIN OUTCOME MEASURES: The questionnaire included items on socio-economic and family background, knowledge about HIV, perceived self-efficacy and behavioural intent regarding AIDS preventive behaviours. RESULTS: Overall, the participants showed an adequate level of AIDS knowledge. However, there was considerable inaccuracy regarding AIDS transmission myths or how AIDS cannot be transmitted. The different cultural groups generally felt most self-efficacious regarding how to protect themselves from becoming infected (75-90%) and least self-efficacious on knowing where to go for information on AIDS (72-74%). Generally, participants reported a high behavioural intent. The Whites stand second in knowledge and more or less second in self-efficacy and behaviour intent. The Blacks stand third in knowledge and more or less second in self-efficacy and behaviour intent. CONCLUSION: Culturally diverse knowledge, self-efficacy and behavioural intent towards AIDS prevention was found among White, Black and Asian pupils, which should inform a culturally sensitive and appropriate AIDS health promotion programme in South Africa.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Country-wide distribution of the nitrile female condom (FC2) in Brazil and South Africa: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost-effectiveness and potential impact of expanded female condom distribution. DESIGN: Cost-effectiveness analysis assessing HIV infections averted annually and incremental cost per HIV infection averted for country-wide distribution of the nitrile female condom (FC2) among sexually active individuals, 15-49 years, with access to publicly distributed condoms in Brazil and South Africa. RESULTS: In Brazil, expansion of FC2 distribution to 10% of current male condom use would avert an estimated 604 (5-95th percentiles, 412-831) HIV infections at 20,683 US dollars (5-95th percentiles, 13,497-29,521) per infection averted. In South Africa, 9577 (5-95th percentiles, 6539-13,270) infections could be averted, at 985 US dollars (5-95th percentiles, 633-1412) per infection averted. The estimated cost of treating one HIV-infected individual is 21,970 US dollars (5-95th percentiles, 18,369-25,719) in Brazil and 1503 US dollars (5-95th percentiles, 1245-1769) in South Africa, indicating potential cost savings. The incremental cost of expanded distribution would be reduced to 8930 US dollars (5-95th percentiles, 5864-13,163) per infection averted in Brazil and 374 US dollars (5-95th percentiles, 237-553) in South Africa by acquiring FC2s through a global purchasing mechanism and increasing distribution threefold. Sensitivity analyses show model estimates to be most sensitive to the estimated prevalence of sexually transmitted infections, total sexual activity, and fraction of FC2s properly used. CONCLUSIONS: Expanded distribution of FC2 in Brazil and South Africa could avert substantial numbers of HIV infections at little or no net cost to donor or government agencies. FC2 may be a useful and cost-effective supplement to the male condom for preventing HIV.

Adolescent↗

PubMed2004

A national survey of oral hygienists in South Africa.

AIM: To survey the status and views of practicing hygienists in South Africa. METHOD: A postal questionnaire was mailed to all registered hygienists in South Africa in 1999 (n = 853). Demographic variables; views on further study; conditions of employment; and issues hygienists' felt strongly about were explored. Two mailings resulted in a response rate of 51% (n = 439). RESULTS: Respondents' age ranged from 20-52 years (mean 33 years); they were all female (n = 435) except two; 60.9% were in full time and 39.1% part time employment; 73% were employed in private practice, 13% in non-traditional settings and a small number in commerce; 92.7% wished to expand on their current qualification with part time and distance learning as the choice of study; 45.7% of the full time and 18% of the part time hygienists reported to have a contract of employment. CONCLUSION: The results of this study show that South African hygienists envision an expanded role within the oral health team and wish to pursue their career beyond the two-year diploma in Oral Health/Oral Hygiene. The majority were not employed according to the BCEA in terms of benefits and the provision of a contract if employment.

Adult↗

PubMed2004

Oral health in South Africa.

This study describes the oral health status of the inhabitants of, and reflects on possible trends in oral diseases in South Africa. During the past 20 years, three national oral health surveys were conducted in South Africa, the most recent, a national Children's Oral Health Survey, was conducted between 1999 and 2002. The results of this study show that 39.7% of the 6-year-old children were caries free, which is below the goal of 50% set by the Department of Health (DoH) for the year 2000. The DMFT of 1.1 for the 12-year-old group, however, was below the 1.5 set by the DoH for this group for the year 2000. Based on the Unmet Treatment Need Index more than 80% of caries in children is not treated. The greatest need for the treatment of dental caries in South African children was for preventive services, restorations and extractions. The DMFT for the 12 year-old-group in South Africa decreased from 2.5 in 1982 to 1.1 for the current survey. Of the same group, 20.2% of the children presented with definite signs of dental fluorosis. The Dental Aesthetic Index was used to assess the prevalence of malocclusion and 32.3% of 12-year-old children needed definitive orthodontic treatment. The results of national surveys showed a reduction in dental caries severity of the permanent dentition of 12-year-old South African children.

Adolescent↗

PubMed1997

South Africa's early experiment in social medicine: its pioneers and politics.

The election of a democratic, nonracial government in South Africa has moved the health needs of the majority of the population to center stage. In the search for precedents, health policymakers have turned to South Africa's pioneering of health centers and social medicine in the 1940s. This paper looks at the intellectual context in which these ideas were first developed; the particular political circumstances and relationships between doctors and the state in the late 1930s, which facilitated the establishment of health centers; the role that the health centers were intended to play in South Africa's wider postwar health plans; and the reasons for the centers' failure. Contrary to conventional wisdom, it argues that the failure of the health centers and the wider health plans predated the advent of the National Party to power in 1948, and resulted mainly from the marginalization of the centers as a low-cost option for the poor, which was itself a consequence of underfunding and the vested interests of local health authorities and private practitioners.

History, 20th Century↗

PubMed1999

Anthelmintic resistance in South Africa: surveys indicate an extremely serious situation in sheep and goat farming.

Surveys to determine the prevalence and degree of resistance of Haemonchus spp. of sheep and goats to the available anthelmintics in South Africa indicate that small ruminant production is entering a crisis situation. Three surveys employing the faecal egg count reduction (FECR) test to determine resistance were conducted in some of the main sheep-producing areas in the summer rainfall region of South Africa, where H. contortus is the principal worm species in sheep. After analyzing the data recorded in the surveys by six different methods, including the RESO test at two different levels of confidence, the results obtained in the least stringent one (geometric mean reduction of the worm egg counts of drenched, vs untreated group of sheep) are reported in this paper, so that if any bias was obtained it would be in the favour of the anthelmintic. In Mpumalanga and KwaZulu-Natal there was anthelmintic resistance in Haemonchus spp. on all the 52 farms surveyed. Sixteen percent of the strains of H. contortus were < 60% susceptible to three of the four anthelmintics tested, and 8% of the strains were < 40% susceptible to all four of the anthelmintics. FECR tests of sheep in six localities in the Lebowa district of Northern Province indicated that even in previously disadvantaged communities where anthelmintic treatment is less intensive, anthelmintic resistance is developing, and is possibly at the level at which the situation on commercial sheep and goat farms in South Africa was 25 years ago. From the data it appears that the level of anthelmintic resistance of H. contortus in South Africa is possibly the highest that has so far been recorded in the world and that strains of it are emerging that may soon not be controllable by treatment with any of the existing anthelmintics. Farmers in the summer rainfall region, if not the whole country, must be alerted to the immediate need for testing the parasite burdens of their sheep for susceptibility to preparations in all four groups of anthelmintic compounds currently available. Alternative methods of integrated worm control, including biological, must be sought and implemented with urgency, to reduce further selection for resistance and to induce reversion of the resistance that has already developed.

Albendazole↗

PubMed1996

Sequence variation and subtyping of human and simian T-cell lymphotropic virus type I strains from South Africa.

We report on the subtyping of South African primate T-cell lymphotropic virus type I (PTLV-I) strains by investigating the LTR region using sequence analysis and restriction fragment length polymorphism (RFLP) techniques. DNA from either uncultured peripheral blood mononuclear cells (PBMCs); cultured PBMC or cell lines of eight human T-cell lymphotropic virus type I (HTLV-I); and two simian T-cell lymphotropic virus type I (STLV-I) strains (Cercopithecus aethiops pygerythrus) were amplified by polymerase chain reaction (PCR), cloned, and sequenced. The samples originated from different geographical regions in South Africa. Phylogenetic relationships were estimated using the neighbor-joining method. The South African HTLV-I strains were of Cosmopolitan origin and similar to each other. RFLP analysis confirmed this subtyping. A divergence of 0.3 to 1.6% between the Cosmopolitan strains was observed, while the divergence between the HTLV-I and STLV-I strains ranged from 6.3 to 7%. The STLV-I strains were closely related to that of a chimpanzee, providing evidence of interspecies transmission.

Animals↗

PubMed1996

Smoking status, knowledge of health effects and attitudes towards tobacco control in South Africa.

OBJECTIVE: To provide data on the South African adult population's smoking status, their knowledge of the health effects of tobacco and their attitudes towards tobacco control in South Africa. METHODOLOGY: A national representative sample of 2,238 adult (> 18 years) South Africans was surveyed by means of an interviewer-administered questionnaire. RESULTS: Thirty-four per cent of adult South Africans smoke (52% male, 17% female). There were notable differences in gender smoking rates for Indians (61% of men and only 7% of women smoke) and blacks (53% of men and 10% of women smoke) but not for coloureds (58% of men and 59% of women smoke). Provinces with the highest smoking rates are the Northern Cape (55%), Western Cape (48%) and North-West (46%). Forty-eight per cent of respondents reported that at least one household member smoked. The majority of the respondents (87%) acknowledged the harmful effects of direct smoking. Fifty-eight per cent were aware that cancer is associated with smoking but only 36% associated heart disease with smoking. Sixty per cent of the respondents have tried to quit at least once for reasons such as the protection of their own health, the expense of tobacco products and because of a medical doctor's advice. Confusion existed with regard to the effects of the cigarette constituents described on cigarette packages. Forty-two per cent of adults incorrectly indicated that nicotine causes cancer while 28% correctly indicated that it causes addiction, and 44% correctly indicated that condensate causes cancer. There is substantial support for a total ban of tobacco advertising on radio (61%), for local authorities to regulate smoking in public places (78%), for government assistance to farmers for tobacco crop replacement (53%) and for an increase in tobacco excise tax if the money is used for health purposes (50%). CONCLUSION: The extremely high proportion of both male and female coloured smokers is a cause for concern and requires prompt action. Knowledge of the specific effects of tobacco in respect of active and passive smoking needs to be improved and this could be a first step towards facilitating behaviour change. The public support that exists for stronger measures against tobacco use, promotion, pricing and growing provides many opportunities for health promotion action.

Adolescent↗

PubMed1998

Migration dynamics and development in rural South Africa: demographic and socioeconomic perspectives.

"This paper addresses five key questions related to migration dynamics and development in rural South Africa: (1) Which individual and household level factors are particularly important in understanding migration patterns? (2) Taken together, are sociodemographic or socioeconomic factors more influential? (3) Do present patterns of migration and remittance flows reflect strategies that connote survival, or do they represent household efforts to advance their well-being and their position in society? (4) Which segments of the population appear to gain or lose from contemporary patterns of migration and remittance flows? and (5) How might remittances shape trends in local level development and equality, or inequality?... The data source is the nationwide representative sample survey ¿Project for Statistics on Living Standards and Development' undertaken in the latter part of 1993."

Africa↗

PubMed2004

Asbestos and mesothelioma in South Africa.

Asbestos has been used by man since 4000 before the Christian era (BCE) in many different parts of the world and for a wide range of functions. Blue asbestos (crocidolite) was first discovered in South Africa in 1805 and within a few years was being mined there extensively. Mining reached its peak in 1977 with >380,000 tons being exported and 20,000 miners employed in the industry. South Africa also has large deposits of white asbestos (chrysotile) and brown asbestos (amosite) both of which have been mined extensively. At the turn of the 20th century, it was noted that those working with asbestos suffered lung disease and in 1960, the link between asbestosis and mesothelioma was established in the Kimberley area of South Africa. Further studies in the 1970s and 1980s showed an alarming incidence of mesothelioma based on pathology reports. The majority of the reported mesothelioma cases result from exposure to asbestos in its many uses in secondary industry although incidence of the condition among miners is also significant. A high proportion of mesothelioma in patients in South Africa is attributed to environmental origin with a high incidence of women and children affected.

Adult↗

PubMed1996

Urbanization and apartheid in South Africa: influx controls and their abolition.

"This study will take up the particular aspects and characteristics of urbanization [in South Africa] from the standpoint of the effects exerted by the apartheid system. It will then examine the trends which have taken place since abolition of the pass laws and restrictions on the influx of blacks into urban areas....[The author considers] the relationship between restrictions on the movement of blacks into urban areas on the one hand and the maintenance of low-wage migrant labor and retention of farmland in home districts on the other."

Africa↗

PubMed1989

HIV infection in South Africa, 1982-1988--a review.

A review of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) in South Africa between 1982 -1988 is presented. One hundred and sixty-six cases of AIDS have been seen in South Africa so far, with a mortality rate of 59.2%. There has been a predicted and alarming increase in the number of cases of AIDS in the black population. A total of 1857 HIV antibody-positive sera have been tested by various laboratories in the RSA, but this figure excludes sera found to be positive in the mining industry. The HIV-positive and AIDS cases include members of all population groups. A number of surveillance studies are presented. These revealed that beyond the groups at high risk for HIV infection the prevalence of this infection is still very low. Of an estimated 710,000 blood donors tested, 244 were positive for HIV-1 antibodies. Although 1 case of HIV-2 infection was detected in South Africa, this does not constitute a problem at present. No evidence of infection with HIV-1 was detected in southern and central African sera taken between 1970 and 1974. In the absence of a vaccine and specific treatment a change of sexual behavior to one of safer sex practices through education is the only means we have of containing the spread of the epidemic.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Asthma management and perceptions in rural South Africa.

BACKGROUND: Many First World countries have endeavored to measure the impact of asthma on individuals with asthma and, in addition to this quality of life evaluation, have attempted to define the quality of care for this common chronic illness. OBJECTIVE: The primary objective of this research probe was to assist the National Asthma Program in South Africa with the formulation and delivery of its outreach program to rural asthmatic patients. METHODS: A discussion/questionnaire document was compiled by Partners in Research from established literature. All interviews were conducted in either the clinics, hospitals, or respondents' homes. Both adult asthmatic patients and parents of pediatric asthmatic patients were interviewed. Interviewing took place at seven rural health clinics across South Africa. Each interview included extensive demographic details, questions on asthma definition, symptoms and symptom triggers, family history, age at diagnosis, frequency of symptoms, and treatment. RESULTS: Thirty-five adult asthmatic patients and 27 parents of pediatric asthmatic patients were interviewed. Of the adults, 40% reported wheezing at least once a week (despite diagnosis and treatment) and 19% of children reported similar symptom exacerbations. Fifty-one percent of adults and 56% of children were awakened at least once a week by cough or wheeze. Quality of life measurement reflected that, on average, 37% of responders were frightened during an acute asthma attack, and 68% of parents reported fearing the death of their asthmatic children. Fifty-one percent of adults and 33% of children had been hospitalized at least once for asthma. Although respondents claimed regular training in use of inhaler device, only 43% of adults completed each step correctly. CONCLUSIONS: There is a great deal of fear and ignorance surrounding asthma and, therefore, there is a real need for a greater level of patient education even in the rural areas of South Africa. In rural South Africa, attention should be paid to nurses, because they play a greater role than doctors in management and education of asthma.

Adolescent↗

PubMed2001

Exposure of rural and urban populations in KwaZulu Natal, South Africa, to fumonisin B(1) in maize.

We surveyed households in rural and urban areas of KwaZulu Natal, South Africa, to assess the exposure of the inhabitants to fumonisin B(1) (FB(1)), a mycotoxin produced by Fusarium verticillioides. In southern African regions maize, used as a staple food by the population, is prone to F. verticillioides infection. Furthermore, high levels of FB(1) in maize have been associated with esophageal cancer in South Africa. We assessed exposure of the population to FB(1) at three levels, namely, by analyzing stored maize, plate-ready food, and feces. The positions of participating households in the rural area were recorded using geographic information systems (GIS) for ease and accuracy of follow-up. Of the 50 rural maize samples examined, 32% had levels of FB(1) ranging from 0.1-22.2 mg/kg, whereas 29% of the 28 cooked maize (phutu) samples contained FB(1) ranging from 0.1-0.4 mg/kg. The incidence and levels of FB(1) in feces were 33% and 0.5-39.0 mg/kg, respectively. Of the 49 urban maize samples analyzed 6.1% had a range of 0.2-0.5 mg/kg FB(1), whereas 3 of 44 fecal samples (6%) ranged between 0.6 and 16.2 mg/kg. No FB(1) was detected in urban phutu samples. Because these levels are lower than those published from regions in South Africa with high incidence of esophageal cancer, it may be concluded that the risk of esophageal cancer from FB(1) exposure is lower in the KwaZulu Natal region.

Carboxylic Acids↗

PubMed1996

Changes in the incidences of the different serovars of Haemophilus paragallinarum in South Africa: a possible explanation for vaccination failures.

Infectious coryza remains an important disease in the poultry industry despite the long-term and widespread use of vaccines against its causative agent, Haemophilus paragallinarum, in South Africa. In order to detect antigenic changes between populations of H. paragallinarum isolated before the use of vaccines against infectious coryza in this country, and field isolates obtained after the introduction of infectious coryza vaccines, 106 different NAD-dependent isolates (of which 93 were identified as H. paragallinarum) from 63 different farms, and dating from 1972 to March 1995, were identified by means of rabbit antisera against serogroups A, B and C. Serogroup C isolates show weaker cross-protection, requiring the further subdivision of this serogroup into its four different serovars. The percentages of the different serovars obtained in the 1970s, confirmed previously published data on South African isolates. A tendency towards a decrease in the number of serogroup A and serovar C-2 isolates, and an increase in the percentage of serovar C-3 isolates, was noted among isolates of the 1980s. These changes were markedly enhanced in the isolates obtained from 1990 to March 1995. The percentage of serogroup A isolates decreased significantly from 34% in the 1970s to only 5% in the 1990s, and that of serovar C-2 isolates, from 31-18%, while the abundance of serovar C-3 isolates increased significantly from 31% in the 1970s to 73% in the 1990s. Serogroup B remained more or less constant and never reached more than 10% of the population. These results indicate the need for the incorporation of serovar C-3 in a vaccine for use in South Africa, particularly in those areas of the country from which isolates were collected during this study. Some of the NAD-dependent isolates obtained from poultry in South Africa between 1970 and 1995, were biochemically identified as Pasteurella avium and P. volantium. As H. avium has been subdivided and reclassified into the genus Pasteurella, this represents the first report of the identification of P. avium and P. volantium in South Africa.

Agglutination Tests↗

PubMed1975

History of mental health services in South Africa. Part XI. Services for alcoholics.

The earliest services for alcoholics in South Africa were begun by private organisations. The first legal steps were taken in 1911. The number of alcoholics in South Africa is discussed and a report on the 'tot system' is given. The facilities for the treatment of alcoholics are described, with special reference to the role of the Department of Social Welfare and the South African National Council on Alcoholism and Drug Dependence.

Alcoholics Anonymous↗