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PubMed1988

Factors associated with oesophageal cancer in Soweto, South Africa.

Cancer of the oesophagus was a rare disease in the South African black population until the last few decades. Increases in incidence have occurred and at present it is the commonest cancer in black men in many parts of South Africa. A case-control study of 200 oesophageal cancer patients and 391 hospital controls has been carried out in order to determine the risk factors in the urban black population of Soweto. The results indicate that the cancer patients were long-term urban residents from a very low socio-economic group. The association between smoking pipe tobacco and oesophageal cancer previously noted in South Africa is confirmed. In addition, consumption of traditional beer was found to be a major risk factor.

Adult↗
PubMed1990

A unitary health service for South Africa.

Medicine throughout the world is facing many critical challenges. In South Africa these are exacerbated by the effects apartheid has had on the structure, funding, distribution and delivery of health care. The demographic, economic, political, ethical and management problems facing our health services and the arguments in favour of privatisation are briefly reviewed. The case against privatisation of health care is buttressed by moral, economic and sociological justification for developing a unitary national health service/insurance system. In a rapidly changing South Africa medical care could become the leading edge of an enlightened social policy, which may facilitate peaceful progress towards a better future for all in our country and sub-continent.

Economics↗
PubMed2000

South Africa: historic "defiance campaign" imports generic fluconazole.

South African treatment advocates have raised national and international issues by purchasing a generic version of fluconazole in Thailand, where it cost 50 50 times less than the South African retail price, and importing it into South Africa in defiance of patent laws. Many Africans die because they cannot afford the South African price of the patented drug. The South African government has been hostile, but the action has been supported by civil society throughout the country and abroad.

Antifungal Agents↗
PubMed2002

Molecular epidemiological analysis of community circulating respiratory syncytial virus in rural South Africa: Comparison of viruses and genotypes responsible for different disease manifestations.

Human respiratory syncytial virus (RSV) is a major cause of severe lower respiratory tract infection in children in both the industrialized and developing world. Most molecular epidemiological studies have, until now, focused on isolates from hospitalized infants in industrialized countries. Limited data have been available with regard to community circulating RSV, especially from Africa. The present study compares RSV isolates from infants attending rural community clinics in the Northern province of South Africa, with isolates from hospitalized infants in Soweto, near Johannesburg, South Africa, during the same period. A multiplex nested polymerase chain reaction was developed for analyzing the clinical specimens, a technique that permits subtyping and nucleotide sequence analysis of the second variable region of the G-protein gene. Community- and hospital-based isolates from young children in South Africa, as well as isolates from Mozambique were compared phylogenetically. One subgroup B community isolate was identified that had a G-protein truncated by approximately 35 amino acids, however, the other community isolates were not significantly different from hospital isolates. Evidence was found that the same RSV genotypes and viruses could cause mild upper respiratory tract infections or lower respiratory tract infections or severe RSV in young infants.

Amino Acid Sequence↗
PubMed1977

Huntington's chorea in the Cape coloured community of South Africa.

Huntington's chorea is a grave genetic neurological disorder which appears to be a more serious problem in South Africa than has generally been recognized. The minimum prevalence of the disease in the Cape Coloured is 3,5/100 000 of the population. Sixteen per cent of patients were younger than 20 years at the time of onset of the disease. This is among the highest incidence of juvenile Huntington's chorea in the world. The gene for Huntington's chorea has been in South Africa for 300 years. It was first introduced into this country from Holland in the middle of the 17th century and then later from England in the middle and end of the 19th century. The number of affected individuals appears to be on the increase in South Africa. Unfortunately, at present, no methods are available for effective control of this disorder.

Adolescent↗
PubMed2005

The neonatal resuscitation training project in rural South Africa.

A paediatrician trainer from Australia (JT) spent 3 months in South Africa to assist with the development of neonatal resuscitation training in rural areas, particularly in district hospitals. The project was initiated by the Rural Health Unit at the University of the Witwatersrand and coordinated through the Family Medicine Education Consortium (FaMEC). The Rural Workforce Agency of Victoria together with General Practice and Primary Health Care Northern Territory covered the salary and international travel costs of the trainer, while local costs were funded by provincial departments of health, participants and a Belgian funded FaMEC project. The trainer developed an appropriate one-day skills training course in neonatal resuscitation (NNR), using the South African Paediatric Association Manual of Resuscitation of the Newborn as pre-reading, and a course to train trainers in neonatal resuscitation. From July to October 2004 he moved around the country running the neonatal resuscitation course, and, more importantly, training and accrediting trainers to run their own courses on an ongoing basis. The neonatal resuscitation course involved pre- and post-course multiple-choice question tests to assess knowledge and application, and, later, pre- and post-course skills tests to assess competence. A total of 415 people, including 215 nurses and 192 doctors, attended the neonatal resuscitation courses in 28 different sites in eight provinces. In addition, 97 trainers were trained, in nine sites. The participants rated the course highly. Pre- and post-course tests showed a high level of learning and improved confidence. The logistical arrangements, through the departments of family medicine, worked well, but the programme was very demanding of the trainer. Lessons and experiences were not shared between provinces, leading to repetition of some problems. A clear issue around the country was a lack of adequate equipment in hospitals for neonatal resuscitation, which needs to be addressed by health authorities. A process of ongoing training has been established, with provincial coordinators taking responsibility for standards and the roll-out of training. A formal evaluation of the project is planned. The project serves as a model for skills training in rural areas in South Africa, and for collaboration between organisations. A number of specific recommendations are made for the future of this NNR training project, which offer lessons for similar programmes.

Allied Health Personnel↗
PubMed2006

South Africa's "rollout" of highly active antiretroviral therapy: a critical assessment.

The number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from < 2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa's performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government's own Operational Plan. The public-sector HAART "rollout" has been uneven across South Africa's nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources--especially nurses--is likely to constrain the growth of HAART coverage.

Anti-HIV Agents↗
PubMed1996

The prognosis of cystic fibrosis in the Western Cape region of South Africa.

OBJECTIVE: To study the prognosis of cystic fibrosis (CF) in South Africa. METHODOLOGY: Retrospective chart review of 102 children with CF over 20 years. RESULTS: Survival at 18 years was 54% (95% confidence intervals 30-79). Prognosis was not influenced by gender or genotype but survival was noted to be worse for Cape Coloured children than for European children. This appeared mainly to be due to the death of eight Cape Coloured Infants, four of whom presented with oedema and anaemia, mimicking kwashiorkor. Infection with Pseudomonas aeruginosa occurred earlier in Cape Coloured children than European children (median, 1 vs 4 years) and they had a worse 5-year survival (58 vs 89%, P < 0.05) after infection. Of the 40 children born in the second decade studied, six Coloured and no European children died. CONCLUSIONS: Ethnic differences in prognosis exist for children with CF in South Africa and are probably related to underrecognition of CF and the socio-economic status of some patients.

Adolescent↗
PubMedDate not supplied

Population policy in South Africa.

This report examines the current state and likely future directions of population policy in South Africa with particular reference to family planning activities set against the background of apartheid and its demise. In the apartheid era, population policy was perceived by most blacks as an instrument for the control of their number and movements. Recently, policy has been adjusted by the national Population Development Program in response to the changing sociopolitical situations in the country. A national post-apartheid population policy is likely to retain many of the components of this new program. However, a future nonracist and democratic society would probably invite a review of population activities in the country and raise wider issues concerning rationales, organization, and strategies for the delivery of family planning in South Africa.

Adolescent↗
PubMed2001

Attitudes and practices of pharmacists towards emergency contraception in Durban, South Africa.

Emergency contraception, which is used to prevent pregnancy following unprotected intercourse, could prove invaluable to a country like South Africa which has high fertility and pregnancy rates. However, the success of emergency contraception is dependent on the awareness, knowledge, attitudes and practices amongst health-care providers and the public towards it. The aim of this study was to assess the attitudes and practices of community pharmacists towards emergency contraception. The study was conducted in North and South Central Durban, South Africa. This questionnaire-based study sought from pharmacists the frequency of demand and supply of emergency contraception, as well as their attitudes and practices towards it. The sample included all 182 pharmacies located in the study area. A total of 96% of pharmacists had received requests for emergency contraception within the last year. On average, each pharmacist received 177 requests for emergency contraception. Sixty-nine per cent of pharmacists were in favor of making emergency contraceptive pills available without a prescription, 62% were already supplying emergency contraceptive pills without a prescription and 67% felt that it was important to increase public awareness regarding emergency contraception. Ninety-one per cent of pharmacists did not have any literature regarding emergency contraception to hand to clients, 68% had a private area in their pharmacy to counsel patients and 86% of pharmacists indicated that they discussed long-term contraception with clients. This study is the first in South Africa aimed at determining the utilization of emergency contraception. However, further studies are required in order to ascertain information that will assist in changing current health policies to improve those in reproductive health care.

Attitude of Health Personnel↗
PubMed1994

Animal traction in South Africa: research priorities in veterinary science.

During June 1994, members of numerous organisations with a vested interest in animal traction in South Africa met for a one-day workshop, the initial activity of a Forum on Working Animals. The workshop was sponsored by the Foundation for Research Development in South Africa. The individuals who attended were representatives of academic and government institutions, farmer and civic organisations, and included veterinarians and veterinary scientists, administrators, traction experts from the region and from abroad, agricultural engineers, sociologist, anthropologists and animal welfare experts. The objectives of the workshop were twofold: to address research priorities in veterinary science for traction animals and to identify future actions. Since it was a one-day workshop only, there was insufficient time to address issues in depth. However, problems were identified and appropriate actions were suggested. These actions were then delegated to a number of participants, to be refined and reported on at a subsequent workshop. Two key questions were considered and discussed by the participants, and a consensus reached for each. The first was to consider which species of traction animals are best suited to South African conditions. It was agreed that, in order of suitability, these are donkeys, cattle, mules and horses. The second question concerned the criteria which determine the usefulness of traction animals to South African communities. Two recommendations were made by the participants. The first recommendation was to design a questionnaire which would address the role of traction animals in the South African community and to identify communities in which the questionnaire would be implemented. At present, no information exists on the demographics of traction animals and their users. A list of questions was suggested and a working group from 6 institutions was identified to address this action. The second recommendation was to develop a research programme to study the 4 species which are most suitable for animal traction in South Africa.

Animals↗
PubMed1995

Human papillomavirus DNA in oesophageal carcinomas in South Africa.

Using morphological criteria, the presence of human papillomavirus (HPV) in oesophageal carcinomas has been inferred in patients from Finland and South Africa. However, studies to demonstrate the viral antigen in tissue sections of these tumours have proved disappointing. This study investigates 48 archival oesophageal carcinoma biopsies from South Africa for the presence of HPV DNA using non-isotopic in situ hybridization (NISH) with HPV DNA probes to HPV 6, 11, 16, 18, 31, and 33. HPV DNA sequences were detected in 25/48 (52 per cent) oesophageal cancers. HPV 16 was present in 84 per cent of the HPV-positive cancers. A NISH type 2 signal pattern (punctate/dot) was present in all HPV-positive tumours. This signal pattern was previously shown to represent integrated HPV DNA within host chromosome. Integrated HPV DNA in oesophageal cancers has also been demonstrated in patients from China and Japan. In addition, the prevalence of HPV DNA in oesophageal cancers from high-risk countries like South Africa (52 per cent) and China (49 per cent) would appear to be consistent.

Base Sequence↗
PubMedDate not supplied

Family medicine in South Africa: where are we now and where do we want to be?

OBJECTIVES: This paper outlines the development of family medicine in South Africa with special reference to the process leading to the recognition of this discipline as a medical specialty. It also examines the constraints under which the discipline has had to function, considers where the discipline should be, seeks to identify the barriers to its further development and suggests ways in which to overcome these. METHODS: A short review was carried out of the available South African literature to record the advancement of the discipline and the international literature was searched for articles supporting this direction. RESULTS: The situation in South Africa is complicated by the existence of many doctor groupings claiming to represent the generalist and the perception that family medicine only addresses the needs of middle-class citizens. A flawed consultative process leading up to the present stage has contributed to this perception. CONCLUSIONS: The available literature supports the establishment of family medicine as a speciality. Developments in South Africa, such as raising the status of Family Medicine and creating a compulsory rotation through family medicine as an extended internship and the creation of registrar posts in family medicine will advance the discipline in a positive manner, whilst possibly attempting to resolve the medical migration issues that are presently destroying Sub-Saharan Africa's health services.

Family Practice↗
PubMed2004

Release from native root herbivores and biotic resistance by soil pathogens in a new habitat both affect the alien Ammophila arenaria in South Africa.

Many native communities contain exotic plants that pose a major threat to indigenous vegetation and ecosystem functioning. Therefore the enemy release hypothesis (ERH) and biotic resistance hypothesis (BRH) were examined in relation to the invasiveness of the introduced dune grass Ammophila arenaria in South Africa. To compare plant-soil feedback from the native habitat in Europe and the new habitat in South Africa, plants were grown in their own soil from both Europe and South Africa, as well as in sterilised and non-sterilised soils from a number of indigenous South African foredune plant species. While the soil feedback of most plant species supports the ERH, the feedback from Sporobolus virginicus soil demonstrates that this plant species may contribute to biotic resistance against the introduced A. arenaria, through negative feedback from the soil community. Not only the local plant species diversity, but also the type of plant species present seemed to be important in determining the potential for biotic resistance. As a result, biotic resistance against invasive plant species may depend not only on plant competition, but also on the presence of plant species that are hosts of potential soil pathogens that may negatively affect the invaders. In conclusion, exotic plant species such as A. arenaria in South Africa that do not become highly invasive, may experience the ERH and BRH simultaneously, with the balance between enemy escape versus biotic resistance determining the invasiveness of a species in a new habitat.

Animals↗
PubMed2003

PPP insights in South Africa.

After functioning for some time in an increasingly regulated and structured environment in dealing with the private sector in South Africa, it was important to Government, to carefully review the terminology used in this evolving playing field. As the definitions and mechanisms impacting on this form of interaction became clear, it was essential to find a broader definition to encompass all forms of commercial intervention between the two sectors. In preparation for the first South African National Health Summit during 2001, the term public private interaction became a general term used in this context. In the South African healthcare sectors this term is used specifically to indicate that all forms of interaction between the two sectors should be considered, rather than merely focussing on specific Public Private Partnerships (PPPs), that have a much more narrow definition. Recent health policy documents in South Africa all stress four key goals--equity, coherence, quality of care and efficiency--which provide a useful basis for decision-making about PPIs. The range of public-private interactions that may support or constrain the South African health system's development are set within the overall public/private mix of the country. In developing an equitable, efficient, coherent and high quality health system in South Africa, there is considerable potential for constructive engagement (collaboration and co-operation) between the public and the private health care sectors. Both sectors should embrace this opportunity and therefore it is useful to propose some basic guidelines for engagement based on the vision and goals of the national health system. In deciding whether or not to pursue any new PPI within the health sector, or in evaluating whether an existing PPI should continue or be revised, it is necessary to assess its merits in relation to the achievement of health system goals.

Community Health Services↗
PubMed2002

Barriers to accessing free condoms at public health facilities across South Africa.

OBJECTIVES: Lack of access to public sector condoms still presents a fundamental barrier to condom use in most of South Africa. This study investigated the determinants of condom procurement at public health facilities in order to inform improved public sector condom distribution and promotion strategies. DESIGN: Cross-sectional study. SETTING: Twelve health facilities in four health regions of South Africa: Boland/Overberg, Empangeni/Jozini, Kimberley, and Pretoria. SUBJECTS: Consecutive individuals procuring condoms and a sample of individuals not procuring condoms were interviewed on their recent sexual behaviour and condom-related knowledge and attitudes. OUTCOME MEASURES: Factors associated with condom procurement. RESULTS: Across all facilities, 554 individuals procuring condoms and a comparison group of 261 individuals not procuring condoms were interviewed. Eighty-three (33%) of those interviewed who were not procuring condoms stated that they would like to do so. Several potential barriers to condom procurement, including female gender and perceived risk of HIV, showed substantially different associations in different study regions. Only two factors, negative partner attitudes towards condoms and the use of other forms of contraception, were consistently associated with a decreased probability of condom procurement across all regions. CONCLUSIONS: These results suggest that the barriers to condom procurement may vary considerably across South Africa. This heterogeneity suggests that national-level interventions to promote condom procurement and use may be less appropriate than specialised interventions addressing locally relevant factors, including those identified here.

Adolescent↗
PubMed2000

Going underground and going after women: trends in sexual risk behaviour among gold miners in South Africa.

This paper examines trends in risk behaviour among South African gold miners, a population with an estimated HIV prevalence of 10-20%. The study is based on a 1995 and 1997 survey of a random sample gold miners in the town of Welkom, South Africa. The results show that the percentage of miners who perceived they were likely to contract HIV increased from 33% in 1995 to 35% in 1997 (P<0.01). The percentage who had 4 or more partners in the past year decreased from 25% to 13% (P < 0.01), and the percentage whose last sexual partner was their spouse increased from 56% to 70% (P<0.01). Condom use in last intercourse with a spouse increased from 18% to 26% (P < 0.05). Condom use with other partners was considerably higher (67%), but did not increase significantly from 1995. The most likely contributors to this behaviour change were the AIDS awareness programmes implemented by the mining industry and the behaviour change communications of a condom social marketing campaign targeted at miners and commercial sex workers in the mining community.

Condoms↗